Factors Influencing Muslim Women’s Decisions about Induced Lactation: A Qualitative Study
Round 1
Reviewer 1 Report
This is an interesting maternal and infant health.
1) It is not clear the purpose of the eligibility criteria. Can the authors expand on the motivation for their eligibility criteria?
2) The authors should be more careful about generalizability claims in their discussion. This is especially true given their eligibility criteria.
3) It isn't clear if this is a qualitative study based on grounded theory. I want more details about the conceptual underpinnings of this study.
Author Response
Response to reviewer 1:
This is an interesting maternal and infant health.
Thank you for the comment.
Point 1) It is not clear the purpose of the eligibility criteria. Can the authors expand on the motivation for their eligibility criteria?
Response 1: By enrolling respondents with such criteria, we can assure that the results are due to the content of our study and nothing else. As a consequence, the qualifying requirements assist us in achieving accurate and relevant results based on the objectives we have established. These criteria also guarantee that women who may be affected by participating in our study are not put at risk.
Point 2) The authors should be more careful about generalizability claims in their discussion. This is especially true given their eligibility criteria.
Response 2: To avoid such claims of generalizability and in compliance with the discussion, we changed the title to "Factors Influencing Muslim Women's Decisions About Induced Lactation: A Qualitative Study."
Point 3) It isn't clear if this is a qualitative study based on grounded theory. I want more details about the conceptual underpinnings of this study.
Response 3: The case study design was the most suited approach for this study. The nature of this case study was sufficient to explain and discuss "what" induced lactation practices used in Malaysia and "how" induced lactation is interpreted and practiced in the country as knowledge of nursing and adopted children increases gradually with adoption practice.
Reviewer 2 Report
The authors explore the compelling and important topic of perceptions around induced lactation among Muslim women in Malaysia. The paper can be improved in the following ways:
1) In the Introduction (line 40), a website is mentioned but with no context or description of what this website contains. I received an error message when I went to this website. Please clarify.
2) In the third paragraph of the Introduction (lines 40-51), more explanation needs to be provided about the significance of having "mahrem" status for Muslims, and "hijab" needs to be defined for non-Muslim readers.
3) In the Introduction, it should be specified that this research has been done on Muslim women in Malaysia. This would better set up the context of the paper.
4) It is difficult to check any of the sources used because citations are numbered in the text but alphabetized in the reference list. Please choose a consistent format.
5) The data is fairly old as it was collected in 2017. This should be mentioned in the limitation section of the Discussion. Induced lactation may be more normalized in the country now, so views may have changed in the past 5 years.
6) In Table 1, the data needs to be summarized in terms of mean (SD) and % distribution (e.g. mean age and SD of mother; percentage frequencies of gender of children; etc.)
7) In Table 2, the main themes should be placed on the left column and sub-themes on the right column.
8) The Discussion was a bit repetitive with the results. The paper would be strengthened by contextualizing the findings in other existing literature. The authors should also highlight that this type of research has not been widely conducted in non-Western countries, and study findings may apply to Muslim populations in non-Western and Western countries alike.
Author Response
Response to Reviewer 2 Comments
The authors explore the compelling and important topic of perceptions around induced lactation among Muslim women in Malaysia. The paper can be improved in the following ways:
Thank you for the comment.
1) In the Introduction (line 40), a website is mentioned but with no context or description of what this website contains. I received an error message when I went to this website. Please clarify.
Response 1: The sentence was revised.
In Malaysia, only 47.2% (n=17) of women who sought help at Breastfeeding Support Centre (Susuibu.com) reported success in the induced lactation process [9]. Others, meanwhile, have not been able to give their adopted children breast milk. This private facility focuses on providing high-quality breastfeeding consultation services, as well as teaching and training to healthcare providers and the general public.
2) In the third paragraph of the Introduction (lines 40-51), more explanation needs to be provided about the significance of having "mahram" status for Muslims, and "hijab" needs to be defined for non-Muslim readers.
Response 2: The sentence was revised.
The term mahram is used to denote a level of relationship between close family members, i.e., those with whom the hijab does not have to be observed. When the non-biological children are breastfed for five times or more within the first 2 years, they indirectly established a milk kinship between them and the baby then becomes her milk son or milk daughter. Therefore, the mother becomes mahram or haram (illegal) to be married to the child she nursed. In Islam, children that consumes milk from the same women is haram to wed each other.
3) In the Introduction, it should be specified that this research has been done on Muslim women in Malaysia. This would better set up the context of the paper.
Response 3: Thank you for the suggestion.
Added: This research has been done on Muslim women in Malaysia.
4) It is difficult to check any of the sources used because citations are numbered in the text but alphabetized in the reference list. Please choose a consistent format.
Response 4: The citation and reference were amended. Sorry for the error.
5) The data is fairly old as it was collected in 2017. This should be mentioned in the limitation section of the Discussion. Induced lactation may be more normalized in the country now, so views may have changed in the past 5 years.
Response 5: Mentioned as suggestion. Thank you.
6) In Table 1, the data needs to be summarized in terms of mean (SD) and % distribution (e.g. mean age and SD of mother; percentage frequencies of gender of children; etc.)
Response 6: Data was summarized in Table 2 in manuscript as suggestion. Thank you.
7) In Table 2, the main themes should be placed on the left column and sub-themes on the right column.
Response 7: Amended as suggestion. Thank you.
8) The Discussion was a bit repetitive with the results. The paper would be strengthened by contextualizing the findings in other existing literature. The authors should also highlight that this type of research has not been widely conducted in non-Western countries, and study findings may apply to Muslim populations in non-Western and Western countries alike.
Response 8: Based on the existing literature, I have thoroughly explained this finding. I also emphasise that this study is solely applicable to the Muslim community.
Amended as suggestion. Thank you.
Round 2
Reviewer 1 Report
I am still confused about the previous points from my earlier review. I understand this is an exploratory study with purposive sampling. However, there are still some lack of clarity about this study. Why did you chose only Muslim women for your sample? By limiting your sample to Muslim women, didn't the researchers set themselves up to find "being a mahram was the main factor" ? Is this study more about Muslim culture than about Malaysian culture?
Author Response
Response to Reviewer 1 Comments
I am still confused about the previous points from my earlier review. I understand this is an
exploratory study with purposive sampling. However, there are still some lacks of clarity about this
study. Why did you choose only Muslim women for your sample? By limiting your sample to Muslim
women, didn't the researchers set themselves up to find "being a mahram was the main factor" ? Is
this study more about Muslim culture than about Malaysian culture?
Thank you for the comment.
Response 1: The selection of women who was undergoing induced lactation procedure (completed
or still under treatment) was obtained from the practitioners who agreed to participate in this study.
The practitioners provided one to ten names of women who were their clients based on the
inclusion and exclusion criteria.
The fact that in this study all of the women who underwent induced lactation were Muslims
presents a limitation in that the findings cannot be extrapolated to other religious groups. In this
study, the women who underwent induced lactation were ethnic Malay Muslims. Thus, comparisons
to other ethnic groups were not possible. This was due to the difficulty of getting women from
different ethnic groups who had undergone induced lactation to participate in the study.
Reviewer 2 Report
I think the authors have revised appropriately and that I recommend that the article is accepted for publication.
Author Response
Thank you for the comments
