OBJECTIVE Traffic crashes are a leading cause of deaths and injuries in Pakistan. The World Health Organization (WHO) estimates that approximately 30,131 people die in road crashes annually on Pakistani roads (WHO 2013). The use of seat belts can be effective in reducing road crash fatalities in Pakistan but under existing seat belt laws, seat belt use is mandatory only for drivers and is limited to specific vehicles and roads. Primarily, this study was aimed to measure seat belt use rates among Pakistani vehicle occupants. It was meant to investigate the factors influencing the compliance behavior of seat belt use among vehicle drivers. The second objective was to gauge the enforcement of seat belt laws and their effectiveness in Pakistan. METHODS A first ever national survey was conducted for the systematic recording of seat belt use rates among Pakistani drivers and front passengers on 5 different kinds of roads. Factors influencing compliance with seat belt use were gauged through a questionnaire for 5 different kinds of roads. Commitment level of different traffic police organizations to enforce seat belt laws was also measured through their previous year's enforcement data. RESULTS Average seat belt use rates were 20% with the highest on motorways (53%) and the lowest on rural roads (5%). Unawareness of the law/usefulness, seat belt not fitted, discomfort, forgetfulness, low speed, and careless attitude were major reasons for noncompliance with seat belt laws among Pakistani drivers. Seat belt use rates were directly proportional to law enforcement strength and the National Highways and Motorways Police (NH&MP) showed maximum enforcement on M-2. There is a dire need to revise existing seat belt laws in order to raise seat belt use rates in Pakistan.