Using Modern Contraception While Wanting a Child: What Does Contraceptive Over-Use Mean for the Human Rights-Based Approach in Burkina Faso? Insights from PMA2020 Data

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The topic is very necessary to address, as the Sustainable Development Goals remind us. The scientific approach is correct, but I would like to make three considerations:

 

-Make sure that the sentences in the summary do not appear in the same way in the body of the article.

 

-It would be convenient to point out some limitations of the study (for example, the date of data collection) as well as some lines of approach for the future.

 

As for the rest, if these small changes are introduced, we understand that it is a well-argued work to be published in the journal.

Author Response

Comments 1: [Make sure that the sentences in the summary do not appear in the same way in the body of the article.]

Response 1: [We have revised the text and the summary to ensure that the sentences are not the same.] Thank you for pointing this out. We agree with this comment because some parts of sentences were the same. Therefore, we have [changed two or three words in each of the cases in the text or in the summary]

Comments 2: [It would be convenient to point out some limitations of the study (for example, the date of data collection) as well as some lines of approach for the future.]

Response 2: Agree. We have added a last sentence to that effect. We do not understand well the issues with the date of the data collection. Are you referring to the oldness of the data? For that, we suggest in the future approach to test that with recent data collected in the same setting. Here is the sentence added “[Another approach could be to monitor the issue using the recent PMA longitudinal data to observe how the overuse evolves yearly and whether it remains confined to the same categories of women.]”

 

 

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Authors,

This paper is excellent.  I have minor comments (you don't hear that every day I bet), mostly questions that are truly questions and that I think might make your paper clearer to more readers.  

You do a pretty good job discussing the difference between the capability framework and the literature on empowerment. You might be able to do a tad better if you look at and reference this new review:  "https://www.sciencedirect.com/science/article/pii/S027795362400323X?via%3Dihub#sec5"The EMERGE framework to measure empowerment for health and development - ScienceDirect

Is there a word missing or some other confusion around lines 86-89?  Is "For this postponement" related to the instability of fertility preferences?  Maybe a stronger segue to explain?

Could you explain why you did not consider (or add if you did consider) a 0-2 children category?  Was it just too small and would make your numbers too small?  

In Table 1, maybe Place of reference might be better described as Urban-Rural.  So people don't think (who are not reading) that you are analyzing by community.  

I think your methods could describe your weights a bit better.  Were you using weighting provided by the DHS?  how were those weights determined and why?  Or you could reference a fuller document.  Similarly, in Table 2, you should probably footnote whether those are unweighted frequencies and weighted percentages, or unweighted data. 

IN Table 2, the last two conversion factors would be clearer if you used the same terminology in the titles as used in the narrative description of results. 

IN the Discussion (which I thought was great), I did wonder if it was possible that wealthier urban women not only had easy access to FP but also had higher healthcare utilization overall, amounting to more interaction with and opportunities for access to FP.  This is a small thing.  

In the Discussion, lines 337-8, perhaps I missed this but I did not see the relationship to contraceptive knowledge described in the tables or results.  Is this the same as method information?  I interpreted this to be about the method they were using?  Might be good to add some clarifying language about these variables.  

Most of my suggestions are small and for clarity but I will note that your paper is thinly referenced.  There were a couple of bodies of literature that I felt could at least be noted in your paper.  No need to go overboard but bias in counselling is pretty well-researched, you should at least consider this review paper: https://www.ghspjournal.org/content/7/3/371?__hstc=175320440.4b44870ec4a577029c49e44b73bd3bee.1673222400137.1673222400138.1673222400139.1&__hssc=175320440.1.1673222400140&__hsfp=3515293548.  I also think that it would be useful to your readers to at least consider referencing other related literature such as on reproductive coercion (Silverman and Pearson come to mind) and on counseling around FP method choices.  

IN the Discussion, in line 394 and elsewhere, you make a great statement about the need for info on LARC removal.  One of the reasons I suggest digging into counseling or QOC literature a bit more is I was wondering if you might be able to take that a step further and make the case that this could be the result of trade-offs in time and other resources (or simply bias and coercion) that over-emphasize counseling focusing on side effects primarily to improve continuation rates? 

Not sure if this is possible but I found myself wanting to understand more about what questions were included already in the PMA and what you had to lobby to add. This would help to understand the feasibility and replicability in other areas.  Perhaps a table with the questions you used/added and recommend?

Congratulations on a great paper and contribution to the literature. 

Author Response

Comments 1 : You do a pretty good job discussing the difference between the capability framework and the literature on empowerment. You might be able to do a tad better if you look at and reference this new review:  "https://www.sciencedirect.com/science/article/pii/S027795362400323X?via%3Dihub#sec5"The EMERGE framework to measure empowerment for health and development – ScienceDirect

 

Response 1 : We have revised the text and cited this reference in due places.Thank you for pointing this out.

 

Comments 2: Is there a word missing or some other confusion around lines 86-89?  Is "For this postponement" related to the instability of fertility preferences?  Maybe a stronger segue to explain?

 

Response 2 : We have revised the text and made it more comprehensible. Thank you for pointing this out.

 

 

Comments 3: Could you explain why you did not consider (or add if you did consider) a 0-2 children category?  Was it just too small and would make your numbers too small?  

Response 3 : We need to have a category of those without a child because we thing they have different behavior as regard to contraception

 

 

Comments 4: In Table 1, maybe Place of reference might be better described as Urban-Rural.  So people don't think (who are not reading) that you are analyzing by community.  

 

Response 4 : Thank you, but there is no mention of "Place of reference" in the text. As for "Place of residence" in Table 1, it is defined as Urban-Rural.

 

 

Comments 5: I think your methods could describe your weights a bit better.  Were you using weighting provided by the DHS?  how were those weights determined and why?  Or you could reference a fuller document.  Similarly, in Table 2, you should probably footnote whether those are unweighted frequencies and weighted percentages, or unweighted data. 

 

Response 5: The weights are provided with the dataset downloaded from the PMA Data Lab. We included details about the weighted analysis and added a reference to the data website in the Data section. We also specified which analyses are weighted in the table descriptions.

 

 

Comments 6: IN Table 2, the last two conversion factors would be clearer if you used the same terminology in the titles as used in the narrative description of results. 

 

Response 6: Thank you for pointing this out. We have corrected. I used the terminology in the narrative and the tables. We also updated the terminology in table 3.

 

Comments 7: IN the Discussion (which I thought was great), I did wonder if it was possible that wealthier urban women not only had easy access to FP but also had higher healthcare utilization overall, amounting to more interaction with and opportunities for access to FP.  This is a small thing.  

Response 7: Thank you for the hypothesis. I checked and found two references that support this connection. We have modified the section accordingly.

 

 

Comments 8: In the Discussion, lines 337-8, perhaps I missed this but I did not see the relationship to contraceptive knowledge described in the tables or results.  Is this the same as method information?  I interpreted this to be about the method they were using?  Might be good to add some clarifying language about these variables.  

 

Response 8: Thank you for asking. It’s the same. The method information refers to the level of knowledge about contraception, and some items are related to the method she is currently using. I’ve added more details about the variable in the methods section.

 

Comments 9:Most of my suggestions are small and for clarity but I will note that your paper is thinly referenced.  There were a couple of bodies of literature that I felt could at least be noted in your paper.  No need to go overboard but bias in counselling is pretty well-researched, you should at least consider this review paper: https://www.ghspjournal.org/content/7/3/371?__hstc=175320440.4b44870ec4a577029c49e44b73bd3bee.1673222400137.1673222400138.1673222400139.1&__hssc=175320440.1.1673222400140&__hsfp=3515293548.  I also think that it would be useful to your readers to at least consider referencing other related literature such as on reproductive coercion (Silverman and Pearson come to mind) and on counseling around FP method choices.  

 

Response 9: Thank you for your comment, as well as the other ideas and references. I was able to incorporate two references for each of the suggested domains..

 

Comments 10: IN the Discussion, in line 394 and elsewhere, you make a great statement about the need for info on LARC removal.  One of the reasons I suggest digging into counseling or QOC literature a bit more is I was wondering if you might be able to take that a step further and make the case that this could be the result of trade-offs in time and other resources (or simply bias and coercion) that over-emphasize counseling focusing on side effects primarily to improve continuation rates? 

Response 10: Thank you for your comment and suggestions. We have reviewed and added a few references related to quality of care (QoC) and the importance of LARC removal.

 

Comments 11: Not sure if this is possible but I found myself wanting to understand more about what questions were included already in the PMA and what you had to lobby to add. This would help to understand the feasibility and replicability in other areas.  Perhaps a table with the questions you used/added and recommend?

Response 11: Thank you for your interest in the questions added to the PMA questionnaire. We have already included a new reference about the module used in the 2018 data collection, which provided the data for our study. In the subsequent round, we added more specific questions about agency and women’s and girls’ empowerment. Table 1 already lists the variables collected and used in this paper.

Author Response File: Author Response.pdf