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Suhasini Rajaram , known by her stage name , Sneha born 12 October , is an Indian film actress , who works in the South Indian film industry. She debuted in the Malayalam film Ingane Oru Nilapakshi , directed by Anil — Babu and was later signed for the Tamil film Virumbugiren , though it was only released two years later. She started getting offers in Tamil and moved her focus to Kollywood; and the movie Ennavale , where she starred opposite R. Madhavan , was released first in the same year. She had her first commercial success with Aanandham in the year She became one of Tamil cinema's contemporary lead actresses in the s, following appearances in several commercially successful films. She debuted in Telugu in the year with the film Priyamaina Neeku , which was a commercial success. Following this, she appeared in some Tollywood films. She has also appeared in a few Kannada language films. Sneha was born as Suhasini in Mumbai [2] to Rajaram and Padmavathy, and is the youngest of four children.
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View research View latest news Sign up for updates. Metrics details. In a cluster randomised controlled trial in Mumbai slums, we will test the effects on the prevalence of violence against women and girls of community mobilisation through groups and individual volunteers.
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View research View latest news Sign up for updates. Metrics details. In a cluster randomised controlled trial in Mumbai slums, we will test the effects on the prevalence of violence against women and girls of community mobilisation through groups and individual volunteers. One in three women in India has survived physical or sexual violence, making it a major public health burden. Reviews recommend community mobilisation to address violence, but trial evidence is limited. Guided by a theory of change, we will compare 24 areas receiving support services, community group, and volunteer activities with 24 areas receiving support services only.

These community mobilisation activities will be evaluated through a follow-up survey after 3 years. Secondary outcomes will describe disclosure of violence to support services, community tolerance of violence against women and girls, prevalence of non-partner sexual violence, and mental health and wellbeing. Intermediate theory-based outcomes will include bystander intervention, identification of and support for survivors of violence, changes described in programme participants, and changes in communities.

Systematic reviews of interventions to prevent violence against women and girls suggest that community mobilisation is a promising population-based intervention. Backed by public engagement and advocacy, our vision is of a replicable community-led intervention to address the public health burden of violence against women and girls.

Registered on 21 February Registered on 22 February Peer Review reports. The United Nations declared a response to violence against women and girls imperative in [ 2 ], and it was identified as a health priority in World Health Organization WHO guidelines of [ 3 ]. Elimination of violence against women and girls in public and private is a target for the fifth Sustainable Development Goal. The question of how to achieve substantial reductions in violence against women in low- and middle-income countries is central to current debate [ 5 ].

The response needs to be multisectoral and to include both prevention and response, supported by research on the effects, costs, and potential scalability of promising interventions [ 6 ]. Other harms to health include sexually transmitted infections, miscarriage, induced abortion, stillbirth, low birth weight, preterm delivery, harmful drug and alcohol use, anxiety and depression, self-harm, suicide, and trans-generational recapitulation of violence [ 4 , 10 , 11 ]. Physical and psychological trauma and fear lead to mental health problems, limited sexual and reproductive control, somatoform conditions [ 4 ], difficulties in seeking healthcare, and lost economic productivity [ 12 ].

Intimate partner violence is endemic, domestic violence extends beyond the WHO definition [ 14 ], to culturally sanctioned household maltreatment [ 15 ], and non-partner sexual violence is reported regularly in the media [ 16 ].

Risk factors for both physical and sexual violence include poverty, exposure to parental violence, childhood maltreatment, limited education, unemployment, young adulthood, mental disorder, substance use, individual acceptance of violence, weak community and legal sanctions, and gender and social norms supportive of violence [ 10 ].

More than million people live in urban India [ 18 , 19 ]. Two-thirds of cities and towns include informal settlements [ 20 ], characterized by overcrowding, insubstantial housing, insufficient water and sanitation, lack of tenure, and hazardous location [ 21 , 22 ]. Women and girls in these communities lack both financial and social resources and also an understanding of the possibility of relief from endemic violence. The SNEHA Society for Nutrition, Education and Health Action programme on Prevention of Violence against Women and Children began in and now includes ten counselling centres across Mumbai, linked with community mobilisation, health services, police, and legal support.

The programme history follows global developments. The emphasis of a first wave of interventions, driven largely by feminist activism, was support for survivors of violence, reduction in secondary perpetration, strengthening legal recourse, and advocacy [ 23 ].

A second wave of interventions, led by groups such as SNEHA, emphasises primary prevention and community activism and takes a public health position: population-based, interdisciplinary, and intersectoral [ 10 ]. The objectives of current efforts are both to respond to the burden of violence and to prevent it from happening [ 23 , 24 ]. The underlying socio-ecological model locates individual personal histories within families, located in turn within communities, and in turn within societies [ 25 ]. There is broad agreement that interventions should operate at multiple levels, from individual to societal [ 26 ].

Of particular interest are interventions that aim to change norms that privilege controlling and aggressive masculine behaviour [ 27 , 28 ]. To achieve these aims, our preventive activities—the complex intervention that the trial will test—involve two kinds of community outreach: group education and enablement, and individual voluntarism. Group education involves women, men, and adolescents.

It aims to develop awareness and understanding of violence, knowledge of rights and recourse, individual and collective local strategies for primary and secondary prevention, and increased confidence and leadership, and to reduce community tolerance and increase bystander action.

Individual intervention involves women volunteers, sanginis , who identify survivors of violence, provide support, connect them with crisis intervention and counselling services, and facilitate police and health service consultation. Sangini response is supported by an innovative mobile electronic platform, Little Sister, which integrates real-time field reports of violence and their interventions with programme services. Our processes increase the social standing and agency of group members and sanginis, digital literacy, employability, and supportive social networks.

Secondary interventions for survivors—the background activities that will be available to both intervention and control groups in the trial—include counselling, liaison with the police, medical attention, mental health intervention, family interventions, and legal recourse.

Our centres offer support from trained counsellors, clinical psychologists, municipal clinicians, visiting psychiatrists, and lawyers. We work with the police in five zones, training cadets and officers, and co-developing, piloting, and introducing guidelines for response to violence against women and girls into police practice.

Components of our model have been adapted and replicated in collaborations with Ekjut in Jharkhand state and with Swasti in five states. We aim to help people understand the gendered nature of violence, so that survivors make decisions, potential perpetrators think again, and others believe that action is possible. As a result of this, people will stand up against violence, individually and collectively, and community members will act to help survivors, will stop accepting violence, and will strengthen community structures that support a conviction that it is unacceptable.

Our hypotheses are that women and girls will be more likely to disclose violence, that communities will become less tolerant of it, and that the prevalences of intimate partner and domestic violence will diminish.

Over and above a package of crisis intervention, counselling, and support services, a community mobilisation intervention delivered in informal settlements for 3 years and involving groups and volunteers will reduce the reported prevalence of domestic physical or sexual violence, and of domestic emotional or economic violence, control, or neglect.

We will test the effects of community mobilisation through groups and volunteers in a parallel-group, phased, cluster randomised controlled pragmatic superiority trial, with allocation to intervention and control in a total 48 urban informal settlement clusters. We will select 48 informal settlement slum clusters, each of dwellings, in Mumbai after vulnerability assessment. We will allocate 24 clusters randomly to receive the intervention and 24 to control. The trial will be implemented in four phases, each including six intervention and six control clusters.

Each phase will begin with a pre-intervention survey. The intervention will be implemented for 3 years in each phase, followed by a post-intervention survey see Fig. Any resident of an intervention cluster may participate in the intervention. Women, men, and adolescents will be eligible to participate in group activities, and women will be eligible to volunteer as sanginis. Two surveys will be administered before the intervention, two at the midpoint of the intervention, and two after the intervention.

An individual participant will respond to only one survey. Data collectors met with no significant problems. We will do a similar thing for the surveys at midpoint and after the intervention. Baseline survey 2 will ask 50 women and men aged 18—65 in each of 48 clusters about gender roles, gender equality, ambivalent sexism, the problem of violence in their home area, attitudes towards and justifiability of violence against women, bystander intervention, and potential sources of support participants.

Post-intervention survey 1 will be administered to women in each cluster participants. Post-intervention survey 2 will be administered to 50 women and men in each cluster participants. The inclusion criteria will be the same as for pre-intervention baseline survey 2. Theory-driven evaluation will include quantitative data from the baseline and post-intervention surveys, quantitative monitoring data, and qualitative data. These qualitative data will be collected by social scientists and ethnographers on the project team.

They will involve interviews with, and observation of, programme participants and team members. Monitoring information will be collected by programme team members from salaried employees and volunteer men and women involved in the intervention. Included will be information on start-up processes, group attendance and meeting content, facilitator performance, community campaigns, and individual and group actions in the community. Exercises with group members will include time expenditure assessments to inform an economic evaluation separate protocol and questionnaires about collective efficacy arising from group work.

Like residents of areas outside our current programme, residents of control clusters will have access to our institutional services for crisis intervention and counselling. Control clusters will receive all SNEHA services, from existing centres in Mumbai, apart from community mobilisation activities: counselling, police liaison, medical attention, mental health intervention, family interventions, and legal recourse.

It now includes five counselling centres and four centres at secondary and tertiary hospitals across Mumbai, all with access to in-house lawyers. It works with the police in five jurisdictions, has co-developed guidelines, and trains police cadets and officers to respond to violence against women and children. The trial will test a combination of group and individual community mobilisation activities on the background of secondary support services and infrastructure.

Interventions will be implemented by salaried community organisers women with higher secondary education, based at community centres , programme officers women or men with graduate education , trained women counsellors, and programme coordinators women or men with postgraduate education. They will follow manuals for sequential 1-year series that will iterate as participants develop over the 3-year programme.

Year 1 will emphasise awareness and knowledge, Year 2 local action, and Year 3 leadership. The sequence covers vision building, communication, understanding sex and gender, social norms, types of gender-based violence, response to violence, and legal support.

Meeting content has been developed from our experience and material adapted from Yaari Dosti, Promundo, and Samyak. The sequence covers gender, sexuality, gender-based violence, leadership, legal awareness, and connections with police. Adolescent groups will be facilitated by programme officers and coordinators. The sequence covers self-awareness, sexual health and hygiene, gender and sexuality, gender-based violence, negotiating relationships, community participation, and mental health.

Campaigns are prominent in our adolescent activities, including drama and dance. Neighbourhood events will be held twice a year and will include activities such as street theatre, games, film screenings, and mini-lectures. For each of the four phase areas, we will convene an offsite workshop twice a year for members of all groups to attend.

Workshops will emphasise movement building against violence, technical knowledge on issues such as finance and government schemes, and interaction with the police and health services. Sanginis will meet monthly an awareness session and a general meeting under the supervision of a programme officer. Awareness session content has been developed from our experience and material from Point of View and Medica Mondiale. The sequence covers personal strengths and weaknesses, sexual violence, mental health, counselling, safety measures, and connections with police.

General sessions are structured around case discussions, requirements for organisational help, and identification of further training needs. They will undertake identification, crisis intervention and preliminary counselling, support, referral, and collective community campaigns.

Community organisers and project officers will record their activities to contribute to programme monitoring and process evaluation, using electronic tablets and netbooks. These are WHO consensus priority indicators www. Proportion of violence against women and girls disclosed to support services non-governmental organisations [NGOs], police, healthcare, government programmes. Communities identify and report violence against women and referrals for early intervention increase.

The participant timeline is summarised in Fig. The four phases of the trial will include pre-intervention surveys, 3 years of intervention, and post-intervention surveys.

This minimum difference is considered conservative because of the 3-year intervention duration. Our power estimates are based on a range of intracluster correlation coefficients ICCs around 0.



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