Differential Experiences of Intimate Partner Violence during COVID-19: A Cross-Regional Study in Mexico.

The COVID-19 pandemic brought on a marked increase in intimate partner violence (IPV) worldwide, Mexico being no exception. Factors that exacerbated gender-based violence (GBV) in the household during the pandemic include gendered loss of income, regression in access to social and legal justice resources, reversal to more traditional gender norms and roles, and increased alcoholism. While there are studies about the prevalence and determinants of IPV in rural and urban Mexico, there appears to be a lack of information regarding how these realities differed as they interacted with the compounding pressures of the COVID-19 pandemic. Stemming from 10 ethnographic interviews with women across rural and urban localities of Oaxaca, Mexico City, and Mexico State, who were recruited from NGOs providing psychological and legal services against GBV, we analyze some factors associated with the prevalence of IPV during confinement. We conclude that all women in our study experienced IPV both before and during the pandemic, with variations in IPV patterns influenced by their rural or urban residence, socio-economic status, ethnic-racial identity, and proximity to the abuser's network. We also found that not all impacts were negative, rather COVID-19 measures had a paradoxical effect for some women where restrictions on geographical mobility and decrease in access to alcohol became pivotal protective factors. We recommend that public policymakers and civil society organizations alike pay attention to these differential challenges and benefits in their crisis responses.

[Problems of the health system in Mexican states with high incidence of maternal mortality]. / Problemas del sistema de salud en estados de México con alta incidencia de mortalidad materna.

OBJECTIVE: To identify and prioritize problems in states' health systems which limit the efficacy of interventions to prevent maternal mortality. MATERIALS AND METHODS: We made a conceptual mapping of priority problems perceived as such by communities of practice (COP) in four states with high ratios of maternal mortality in Mexico. Then, the four COP reviewed the literature and refined their formulation of previously identified problems. RESULTS: Priority problems focused on emergency obstetric care (EmOC), specifically: inadequate financial resources (Guerrero), substandard training among available EmOC providers (State of Mexico), inefficiencies in existing EmOC networks (Oaxaca) and inadequate knowledge of, and/or compliance to, standard EmOC protocols (Veracruz). The literature review confirmed the pertinence of problems previously identified by COP through conceptual mapping. CONCLUSIONS. The four COP showed a high level of congruency between their original perception of problems in the states' health systems and international scientific evidence. Identified problems and their reformulation based on evidence help identify solutions adaptable to local contexts.

Problemas del sistema de salud en estados de México con alta incidencia de mortalidad materna / Problems of the health system in Mexican states with high incidence of maternal mortality

OBJETIVO: Identificar y priorizar problemas de los sistemas estatales de salud que limitan la eficacia de las intervenciones para prevenir la mortalidad materna. MATERIAL Y MÉTODOS: Se realizó un mapeo conceptual de los problemas prioritarios percibidos por comunidades de práctica (Cop) en estados con alta incidencia de mortalidad materna. Posteriormente, las Cop revisaron la literatura médica para contrastar los problemas identificados. RESULTADOS: Los problemas priorizados por las Cop se enfocaron en la atención de la emergencia obstétrica (AEO), específicamente en recursos financieros y desabasto de insumos (Guerrero), falta de capacitación del personal para atender la EO (Estado de México), ineficiencia de las redes obstétricas (Oaxaca) y desconocimiento y falta de adherencia a protocolos de AEO (Veracruz). La revisión de literatura médica confirmó la pertinencia de los problemas identificados mediante el mapeo conceptual. CONCLUSIÓN: Las Cop pusieron en evidencia un alto grado de congruencia entre la percepción de los problemas de los sistemas estatales de salud y la evidencia científica internacional. Los problemas identificados y reformulados con base en la evidencia facilitan la identificación de soluciones apropiadas.

OBJECTIVE: To identify and prioritize problems in states' health systems which limit the efficacy of interventions to prevent maternal mortality. MATERIALS AND METHODS: We made a conceptual mapping of priority problems perceived as such by communities of practice (COP) in four states with high ratios of maternal mortality in Mexico. Then, the four COP reviewed the literature and refined their formulation of previously identified problems. RESULTS: Priority problems focused on emergency obstetric care (EmOC), specifically: inadequate financial resources (Guerrero), substandard training among available EmOC providers (State of Mexico), inefficiencies in existing EmOC networks (Oaxaca) and inadequate knowledge of, and/or compliance to, standard EmOC protocols (Veracruz). The literature review confirmed the pertinence of problems previously identified by COP through conceptual mapping. CONCLUSIONS. The four COP showed a high level of congruency between their original perception of problems in the states' health systems and international scientific evidence. Identified problems and their reformulation based on evidence help identify solutions adaptable to local contexts.

Mapping of health system functions to strengthen priority programs. The case of maternal health in Mexico.

BACKGROUND: Health system strengthening is critical to ensure the integration and scaling-up of priority health promotion, disease prevention and control programs. Normative guidelines are available to address health system function imbalances while strategic and analytical frameworks address critical functions in complex systems. Tacit knowledge-based health system constructs can help identify actors' perspectives, contributing to improve strengthening strategies. Using maternal health as an example, this paper maps and analyses the health system functions that critical actors charged with formulating and delivering priority health programs consider important for their success. METHODS: Using concept mapping qualitative and statistical methods, health system functions were mapped for different categories of actors in high maternal mortality states of Mexico and at the federal level. Functions within and across maps were analyzed for degree of classification, importance, feasibility and coding. RESULTS: Hospital infrastructure and human resource training are the most prominent functions in the maternal health system, associated to federal efforts to support emergency obstetric care. Health policy is a highly diffuse function while program development, intercultural and community participation and social networks are clearly stated although less focused and with lower perceived importance. The importance of functions is less correlated between federal and state decision makers, between federal decision makers and reproductive health/local health area program officers and between state decision makers and system-wide support officers. Two sets of oppositions can be observed in coding across functions: health sector vs. social context; and given structures vs. manageable processes. CONCLUSIONS: Concept mapping enabled the identification of critical functions constituting adaptive maternal health systems, including aspects of actor perspectives that are seldom included in normative and analytical frameworks. Important areas of divergence across actors' perceptions were identified to target capacity strengthening efforts towards better integrated, performing health systems.

[Problem mapping by state and federal actors for maternal health attention]. / Mapeo de problemas para la atención a la salud materna por actores estatales y federales.

OBJECTIVE: To analyze the characteristics of problems in the health system that present barriers to maternal care, according to their representation and rating by officials in different positions and social contexts. MATERIAL AND METHODS: Workshops were held with state health system officials from Mexican states with high maternal mortality (Mexico, Guerrero, Oaxaca and Veracruz) as well as with federal officials. A total of 99 health system problems were identified. Using concept mapping, 94 officials rated problems according to importance and feasibility; they were grouped into issues. Data was analyzed according to state/federal levels and the responsibilities of participants. The association was measured between responsibility profile/social context and priority issues. RESULTS: The issues of highest priority for maternal health care are infrastructure, personnel hiring and financial resources. The importance of certain issues depends on context and, to an extent, on the actors' responsibilities. CONCLUSIONS: There is consensus among actors to address the principal maternal health problems in Mexico. Important differences correspond to context. The usefulness of concept mapping to analyze problems was demonstrated.

Mapeo de problemas para la atención a la salud materna por actores estatales y federales / Problem mapping by state and federal actors for maternal health attention

OBJETIVO: Analizar las características de problemas del sistema de salud que obstaculizan la atención materna, según los representan y califican funcionarios en diversos puestos y contextos sociales. MATERIAL Y MÉTODOS: Se realizaron talleres con funcionarios de estados de alta mortalidad materna en México (México, Guerrero, Oaxaca y Veracruz) y a nivel federal. Se identificaron 99 problemas en los sistemas de salud. Utilizando mapeo conceptual, 94 funcionarios calificaron los problemas según importancia y factibilidad y se agruparon en regiones. Se analizaron los datos según estado/federación y responsabilidades de los participantes. Se midió la asociación entre perfil/contexto y la priorización de las regiones. RESULTADOS: Las regiones de alta prioridad para la atención materna son infraestructura, contratación de personal y recursos financieros. La importancia de algunas regiones depende del contexto social, aunque también en parte del perfil de responsabilidades de los actores. CONCLUSIONES: Existe consenso entre actores para enfrentar los principales problemas de salud materna en México. Diferencias importantes se deben a diversos contextos. Se demostró la utilidad del mapeo conceptual para el análisis de problemas.

OBJECTIVE: To analyze the characteristics of problems in the health system that present barriers to maternal care, according to their representation and rating by officials in different positions and social contexts. MATERIAL AND METHODS: Workshops were held with state health system officials from Mexican states with high maternal mortality (Mexico, Guerrero, Oaxaca and Veracruz) as well as with federal officials. A total of 99 health system problems were identified. Using concept mapping, 94 officials rated problems according to importance and feasibility; they were grouped into issues. Data was analyzed according to state/federal levels and the responsibilities of participants. The association was measured between responsibility profile/social context and priority issues. RESULTS: The issues of highest priority for maternal health care are infrastructure, personnel hiring and financial resources. The importance of certain issues depends on context and, to an extent, on the actors' responsibilities. CONCLUSIONS: There is consensus among actors to address the principal maternal health problems in Mexico. Important differences correspond to context. The usefulness of concept mapping to analyze problems was demonstrated.