Motherhood, Human Trafficking, and Asylum Seeking: The Experiences and Needs of Survivor Mothers in Birthing and Postnatal Care
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsThank you for the opportunity to review this manuscript. The paper explores an important yet understudied topic and offers practical recommendations for strengthening birthing and postnatal care. While this paper offers a novel contribution to the literature, changes are recommended to strengthen the manuscript.
Materials and Methods
- The authors describe the data collection as twofold: live, semi-structured discussions, and online staff survey. However, from reading in latter portions of the Materials and Methods section, it appears that the authors engaged in three forms of data collection: 1) focus group discussions (FGDs), 2) in-depth interviews/one-on-one discussions, and 3) an online survey. Can the authors please clarify this in the beginning of the Materials and Methods section?
- It is recommended that the authors insert a demographic table for the research participants, including those who joined the FGDs, in-depth interviews/one-on-one discussions, and the online survey.
- The authors mention an Expert Advisory Group (EAG) without giving further context on how this group was identified and their specific role in the project. Please include additional information regarding how the EAG was identified/formed, the composition of the EAG, the forms of expertise demonstrated by EAG members, and specifically how the EAG was engaged in the project in providing advice.
- The authors mention that one cultural group was invited to join one-on-one discussions instead of FGDs due to advice from the EAG. Given the sensitivity of the topic and vulnerabilities of the population studied, why was this group the only group selected for individual discussions? Further information could be beneficial here.
- The authors noted that around 20% of the mothers who participated in the study had experienced trafficking or exploitation. What are the backgrounds of the other 80% participants? To contextualize the findings and recommendations, it would be helpful to understand more about the backgrounds of the other participants. Did the authors see any differences in the experiences and recommendations of participants based upon their varying backgrounds of exploitation? Are there implications for the study recommendations?
Findings
- The authors integrated brief quotations from participants throughout the Findings section. However, it would be beneficial to include more quotations directly from participants. Can the authors please include longer quotations from participants throughout the findings section so that the reader can hear more of the participants’ perspectives in their own words?
- Were the findings the same or similar across participant sub-groups (mothers vs. staff and volunteers? Mothers from different cultural groups?). One of the strengths of this study is the inclusion of both mothers from differing backgrounds as well as providers. Incorporating discussion of similarities and differences in the findings/perspectives from various sub-participant groups could enrich the discussion further.
Discussion
- The discussion mentions that the project sees benefits to co-design with service users, inclusion of the EAG, and staff and volunteer inclusion of mothers with lived experience. Can the authors please elaborate on this further? How specifically did these enhance mothers’ experiences and services provided?
Comments on the Quality of English LanguageEditing
- Editorial changes are recommended throughout the manuscript in relation to grammar, word choice, and clarity. Careful editing is needed to address various grammatical issues throughout the paper. Additionally, it is advised that the authors carefully review the entire manuscript to ensure the wording is consistently clear and comprehensible for the reader.
Author Response
Please see attached document with notes related to our response.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for AuthorsPlease make the methodology section clearer by including not only the total number of participants in each case, but specifying how many were the current recipients of the service and how many were the peer volunteers. A further explanation of this role would be helpful. Also, there were many languages and cultures represented among participants, please note if back translation was used and provide some more context of the mothers' cultures of origin in relation to motherhood practices.
Author Response
Please see notes related to our response in the attached document.
Author Response File: Author Response.pdf
Reviewer 3 Report
Comments and Suggestions for AuthorsThis manuscript explores the maternal care needs of asylum seekers/refugees and survivors of modern slavery and human trafficking in the UK. The study aimed to collect data to evaluate a perinatal support project serving this population group and identify gaps in provision. The study is conducted in collaboration with two third sector providers in this field, and involved, as participants, staff members of the providers and their clients.
The study is of interest and in fact on an under-studied area, in particular in relation to modern slavery and human trafficking. The role of doulas in particular, nested within a more culturally competent approach to maternity care, is a strong aspect - despite the fact that the other issues of relevance in this study - namely, perinatal mental health and cultural competence in maternity care among migrant groups and minorities - have been extensively explored in the literature. Global health literature could also help give context to this work.
Authors should make greater effort to turn the study report into a scientific article of international relevance. The manuscript lacks the structure of an academic paper, across all its sections. The literature review should be refreshed and used as the manuscript background. The methods section needs re-ordering and re-structuring, some clarifications (such as how the social support theory fits in), and it is missing some details (such as data collection period). The presentation of the results needs also rewriting, it often sounds more as a description of the clients and the project, rather than a presentation of themes identified with the data analysis. The discussion section would need more engagement with literature, tying the results to previous work and showing their novelty and their implications.
I have provided detailed comments in the pdf attached.
Comments for author File: Comments.pdf
The linguistic register is sporadically too colloquial and some connections between paragraphs and sections is unclear, hence the flow of the arguments and of the whole article does not always work.
Author Response
Please see notes related to our response in the attached document.
Author Response File: Author Response.pdf
Round 2
Reviewer 3 Report
Comments and Suggestions for AuthorsThank you for reviewing this manuscript which has significantly improved in clarity and structure. I would suggest some further improvements:
- title, how about having motherhood first?
- the abstract, despite unstructured, should be rewritten having in mind the Background/Aim/Methods/Results/Conclusion/Implications structuring. The abstract should clealry reflect sections and main contents of the main text.
- introduction. I would rephrase the second, new sentence of paragraph 3; I would reconsider the first sentence of paragraph 4. I am not fully sure that the lenghty addition of the EAG and the peer support add significant messages to this paper. I would keep the paragraph before the sub-section 'background' for the methods section. Where did you run your searches with those keywords? On a search engine or specific data base or?
- methods, this is a mixed-method study (unclear if the survey was mixed or only qual), and it should be stated so at the beginning of the section, after having clarified the study aim in the previous section. I am not sure why authors use an unusual terminology, such as 'approach' or 'methods of engagement' and do not stick instead to simple and straightforward subheadings, such as and in this order, Study Desing, Sample/Recruitment and Setting (the project could be explained here - some authors describe participants here, others in the results section), Data collection (FG, Survey and Interviews), Data analysis (here explain your theory, or if broader than a theory applied to data analysis, have it more succintly in the study design, if very key to the whole project expand what you currently have in the intro, and then refer to it when you describe your data analysis approach. What you have now re the Social Support Theory is not fit for a methods section. Sometimes it seems that the SST informed more the service provision rather than this study regarding that service provision), Ethics and Rigour (including consent)
- Findings, Could the list of items reflecting the chronology of women's experience that we have in the first new paragraph correspond more tightly to the sub-headings? 3.1 is confusing. 3.8. also missing from the initial list. It seems that the doula's role cut through a number of these themes, not just breastfeeding. I would consider deleting or moving first three paragraphs or page 16, it does not seem to fit, if we are talking about perceived gaps. I would drastically reduce 3.8 to a succint overview, or list, even a table. And in general reduce words of the Findings (and of the whole manuscript). Participants codes for quotes to be explained. Participants codes for quotes to be explained.
- discussion, Ensure the study aim at the onset is consistent with what you had in the intro/method. I appreciate the human rights angle of the SI, and that this paper falls into the topic Meeting the rights of the trafficked person. While UK and legislative frameworks are drawn in, a closer discussion of the specific findings of the study in relation to motherhood in trafficking and trafficking care using relevant critical literature and similar cases, in other countries or populations, would have enhanced the quality and the impact of this contribution. A useful structure to keep in mind when writing the discussion is: Principal results, Strenghts and Limitations, Comparison with Previous work, Implications, Conclusions.
- I would invite authors to add a note, possibly in the methods, on the research team/ themselves making explicit their background and position, this is sometimes called Reflexivity/Positionality Note.
Author Response
See attached
Author Response File: Author Response.pdf
