Karo-Kari is a type of premeditated honour killing, which originated in rural and tribal areas of Sindh, Pakistan. The homicidal acts are primarily committed against women who are thought to have brought dishonour to their family by engaging in illicit pre-marital or extra-marital relations. In order to restore this honour, a male family member must kill the female in question. We conducted a systematic review of the published literature other sources on karo-kari and related forms of honour killing or violence against women. Media and non-governmental organization reports were utilized for case studies and analysis. Although legally proscribed, socio-cultural factors and gender role expectations have given legitimacy to karo-kari within some tribal communities. In addition to its persistence in areas of Pakistan, there is evidence that karo-kari may be increasing in incidence in other parts of the world in association with migration. Moreover, perpetrators of `honour killings' often have motives outside of female adultery. Analysis of the socio-cultural and psycho-pathological factors associated with the practice of karo-kari can guide the development of prevention strategies.