Community interventions to prevent violence against women and girls in informal settlements in Mumbai: a theory-driven, pragmatic, cluster-randomised, controlled trial.

Abstract

Domestic violence harms women and girls, their families, and society. It takes multiple forms-physical, sexual, emotional, coercive control, economic abuse, and neglect-and comes from both intimate partners and other family members. We assessed the effects of community mobilisation on disclosure and support for survivors, community attitudes to, and prevalence of domestic violence. We did a two-arm, cluster-randomised, controlled trial in 48 clusters of 500 households. In each of 24 intervention clusters, we facilitated 20 meetings annually of three women's groups and six meetings of a men's group and a youth group. Community participants became volunteer activists, supporting survivors and linking them with caseworkers. We did cross-sectional surveys before and after the intervention: with women to understand prevalence of domestic violence, and with women and men to understand attitudes. The two primary outcomes were physical or sexual domestic violence and gender-based household maltreatment (emotional or economic violence, coercive control, or neglect), by any household member, reported for the preceding 12 months by women aged 18-49 years. We analysed pre-intervention and post-intervention survey data jointly with mixed-effects logistic regression models by intention-to-treat. This trial is registered with ISRCT, ISRCTN84502355, and with Controlled Trials Registry of India, CTRI/2018/02/012047. Intervention activities ran from March 5, 2018, to Jan 27, 2023. 2448 (67·9%) of 3606 women survey respondents reported that tolerance of domestic violence had fallen, 4121 survivors of violence were identified, and 3773 saw a caseworker. Prevalence of physical or sexual domestic violence before intervention was 13·5% (328 of 2429 respondents) in the control group and 15·2% (378 of 2484 respondents) in the intervention group. Post-intervention prevalence of physical or sexual domestic violence was 13·5% (484 of 3592 respondents) in the control group and 11·8% (426 of 3606 respondents) in the intervention group (adjusted odds ratio 0·85, 95% CI 0·62-1·16). Baseline prevalence of gender-based household maltreatment was 57·7% (1401 of 2429 respondents) in the control group and 59·7% (1482 of 2484 respondents) in the intervention group. After intervention it was 53·3% (1915 of 3592 respondents) in the control group and 52·0% (1875 of 3606 respondents) in the intervention group (0·93, 0·66-1·33). Disclosure of violence was likelier in intervention clusters (45 of 484 in the control group vs 89 of 426 in the intervention group; adjusted odds ratio 2·75, 95% CI 1·73-4·37). Although we saw increases in women's disclosure and access to support, the entrenchment of domestic violence and the challenge of measurement meant that we were not able to confirm effects on population prevalence. Wellcome Trust.