Reviewer ’s report  
 
Title: Pattern and correlates of out -of-pocket payment (OOP) on female ster ilization in India, 
1990 -2014.  
 
Version: 0 Date: 25 Feb 2019  
 
Reviewer: Gita Pillai  
 
Reviewer's report:  
Important and  interesting topic.  Congratulations to the author for the submission.  
 
Some careful reworking is required prior to resubmission.  Here are a few things to consider.  
1. Many private providers also provide government compensation for sterilization through 
public private partnership programs in priority states.  So, use of private providers does not equal 
non-receipt of the public good or of subsidized or free sterilization services.  There is an 
intentional effort by the government to shift services to privat e providers, and make it available 
for free at these private and trust hospitals.  
 
2. The term "incentive" should be replaced with "compensation," in line with references to 
government policy and program documents. It is considered compensation for lost wag es and 
transportation etc.   Incentive is usually avoided.  The compensation is set low enough that 
people do not access sterilization because they need the compensation costs and it implies no 
coercion in incentivizing sterilization receipt.There is irrel evant mention of content, such as the 
compensation being INR 10 in 1952 (Almost 70 years ago! - so what?).  Yes, there is an increase 
in the amount over the past 70 years.  
 
3. Discussion of investment in family planning and sterilization with the aim of re ducing 
population growth is also not relevant or acceptable today. Most Indian states have already 
achieved or are below replacement level fertility. Focus of both the government and NGO sector 
is on helping couple achieve their desired family size, even i n higher fertility states.  
 
4. Author says,  since 2005 Progress is yet to happen in the area of family planning?!  
Please review the data again in terms of reduction in ASFR and TFR by state.  The progress has 
been good.  
 
5. Writing requires improvement - both in conceptual presentation of the topics discussed, 
sentence structure and grammar, and clarity of communicating precise meaning.  For example, 
consider the sentence, "It was launched as a clinical approach, redesigned to extension education 
approach f ollowed by cafeteria approach."  By clinical approach do you mean that services are 
provided by a clinician?  In which case, it is still clinical.  By extension, do you mean outreach to 
inform people about services, which it has always done.  Cafeteria app roach is not widely 
understood, and the connection to client choice to a wider range of methods needs to be more 
explicit.  
 
6. Data handling, analysis, and interpretation.  This needs a careful look.  More than I have 
time and information to do right now.  Some questions …  
- For the variable OOPE, Does total amount spent on sterilization include - loss of wages, 
transport to and from facility, expenses for food and child care during hospital stay, lab fees for 
any tests done, payments in cash or in kind, for mal or "informal" given to persons working at the 
facility?  
 
7. Overall, good first effort to take a closer look at this complex topic of out of pocket 
expenditure for sterilization services.  Conclusion with current importance might include the 
value adde d in the increase of private providers providing family planning services to ensure all 
couples have access to achieve their desired family size. Hence the government program has 
successfully achieve improvements in both choice of method as well as choice of providers.   
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Unable to assess  
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Unable to assess  
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable for publication unless extensively edited  
 
Decl aration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents  relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I  declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have NO competing interests  
 
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