‘Violence against women is not a public health problem’: Barriers and facilitators to providing health care for survivors of intimate partner violence in Mexico City

Violence against women (VAW) remains an urgent public health crisis globally. In Mexico, 39.9 % of women over age 15 have reported experiencing intimate partner violence (IPV) in their current or past relationships. Although Mexico has made significant progress toward addressing this issue through numerous policies and regulations, the status of implementing those policies is unknown. This study identifies the facilitators of and barriers to providing health services for survivors of IPV in Mexico City at the policy, facility, and individual health care worker (HCW) levels. Seventy-six qualitative interviews were conducted with key informants, including policymakers, facility managers, and health care workers. Data were analyzed thematically and organized across health system levels. We found that the Federal Ministry of Health was not considered a leader in VAW response, and facility managers displayed limited prioritization of VAW. The greatest facilitator of care was having a Specialized Service unit with dedicated staff to support IPV survivors. HCWs reported some knowledge and skills for addressing IPV in patients, but many did not feel prepared, especially for the emotional aspects of care, and burnout was common. A significant barrier to care was HCW’s reluctance to engage with IPV patients or their cases for reasons such as the normalization of violence or hesitance to participate in the justice system. Despite progress towards addressing IPV in Mexico, addressing barriers to service delivery would improve the effectiveness of the health system's response to IPV, ultimately improving health outcomes for survivors of violence.