Political commitment and implementation: the health system response to violence against women in Mexico.

Violence against women (VAW) is a widespread concern globally and in Mexico, where in 2021, 44% of women over age 15 have experienced some form of intimate partner violence during their relationship and a quarter have experienced sexual violence in the past 12 months. To respond, Mexico passed comprehensive legislation addressing VAW, which outlines the role of the health system in identifying, treating, and referring women experiencing violence; however, implementation of such regulations has been slow and far from successful. Using a conceptual framework of political commitment, we conducted a health policy analysis to evaluate how health policies addressing violence against women in Mexico have been implemented. The political commitment framework includes the dimensions of expressed, institutional, and budgetary commitment. We adopted a multi-methods qualitative case study approach combining document analysis with 25 stakeholder interviews with policymakers and health facility directors in Mexico City. The results show that Mexico exhibits limited expressed political commitment from the president, but some commitment exists among Ministry of Health officials. We document that the mixed findings on expressed commitment are mediated, in part, by internalized social and gender norms that normalize and tolerate violence, which are present in society writ large. We find that institutional commitment exists through policies and institutions. However, monitoring systems for policy implementation were not working as designed, and there was limited effort and capacity to implement these policies, reflecting structural barriers and norms within the health system that shape the treatment of violence survivors. Finally, we found a budgetary allocation for VAW; however, it was unclear if the budget was utilized correctly. While progress has been made in addressing VAW in the health system in Mexico, implementation is lagging due to a lack of political commitment, and thus, policies are likely not reaching their intended beneficiaries: survivors of violence.