Title: Partner support and women contraceptive use: Insight from urban poor communities in
Accra, Ghana.
Version: 4 Date: 16 Nov 2021
Reviewer:  Daniel Yaw Fiaveh
Reviewer's report:
Dear Authors,
I have read your interesting paper which examines the influences of male partners on women
contraceptive choices. I like the idea and attempt but I honestly feel the paper is poorly
conceptualized and underdeveloped, i.e., under theorised and would require further details.
Some specific comments to improve the paper:
1. The title of the paper is problematic. Is the running head seeking to ask a question or making
a statement?
2. This study proceeds from a very incorrect premise, that there is a low prevalence of
contraceptive use in Africa south of the Sahara and Ghana. Which kind of contraceptive? The
paper then proceeds to claim that ‘husbands’ (I presume men) are in opposition to women’s
contraceptive use. This is very problematic. What is the basis for this claim? How would a man
know that a woman has taken a pill for instance? The assumption is negatively skewed and
flawed.
3. It claims that little is known about the influence of men in contraceptive related choices of
their partners from the perspective of urban poverty. What does this mean? Very convoluted.
The paper claims that previous studies have shown a trend of male influence on women then
proceed to contradict that little is known about men’s influence from urban poverty. The
conceptualization is very weak. This study focuses on what women (married and in a union)
said yet generalizes that male partner [non]support of contraceptive related choices impacts
negatively on female/women’s contraceptive use. This assertion is not only problematic but
speculative.
4. More importantly, there was no link whatsoever establishing an association between urban
poverty and women contraceptive use which the title seems to suggest. How different is this
finding from other communities which may not be regarded as poor. How does a variable on
household wealth quintile of woman be the basis to conceptualize the findings? This paper would
need reconceptualization and organization.
5. Concepts were used vaguely without interrogation. What is urban poverty? Because a
community is characterized by lower socioeconomic status and limited access to essential health
services means the individual women interviewed are poor? This is very problematic. Who is
a partner? What is a contraception? How different is contraception from contraceptives and/ or
family planning methods? What does it mean to say women in union? Is it different from those
married because it has implications for ‘so-called’ partner influence?
6. The study seems to be premised on the concept of masculinity, in particular, dominant
masculine ideals/hegemonic masculinity, yet makes no references whatsoever to this concept
or at least have a concept/theory guide the study. The assumptions are only premised on
woman’s report of partner support in contraceptive related choices. There is plethora of work
on masculinity and its impact of women and men in Ghana. Please refer to the works of Daniel
Fiaveh, Isaac Dery and others such as Stephan F. Miescher, Sjaak Van der Geest, John Kuumuori
Ganle and co, Mensah Adinkrah, etc.
7. The inclusion and exclusion criteria for the sampled respondents were women married and
in a union of reproductive age(s) 16-44 years, who lived in the study area at the time of the
interview, could communicate in English or local language, and had no diminished or limited
mental capacity. What do these mean? For instance, how do you access the mental capacity
of your respondents? Do 16-year-olds and those below age 18 have limited mental capacity in
regard to the subject under study?
8. The dependent variable was based on “type of current contraceptive method”; classified
as traditional (e.g., withdrawal, calendar and rhythm methods) versus modern method (e.g.,
IUD, implants, injectable, oral contraceptive pills, emergency contraceptives, condoms and
Lactational Amenorrhea Method). How can a man determine a woman’s decision to use the
calendar method or not for example? This is not clear. How can a man know, for example, that a
woman has used oral contraceptive; say pills before or after sex? It is important to acknowledge
that some of the contraceptive choices/methods are gendered, yet no analysis whatsoever was
made.
9. The independent variable for the study was “women’s report of partners support in
contraceptive related choices.” The central question was interestingly not dichotomous: does
husband/partner support in choices related to a woman’s contraceptive use or not?” with the
response options “Yes”, “No” and “Don’t Know”. So if a woman responds “Don’t know” what
happens? What about the kind of contraceptive choices supported or not in case of a “Yes” or
a “no” response? What were the specific contraceptive choices provided to the respondents to
select from, say multiple responses or something? These details were entirely missing. How
then, using a vague question (“does husband/partner support in choices” or not), conclude that
men do not support women’s contraceptive choices when there are choices for “Don’t know”?
10. The findings were presented as if the interviewees were discussing the fact but interviewees
were discussing their general perceptions and the data should have been thoroughly interrogated
or nuanced.
11. It would have been more interesting to provide further details about how questions on wealth
index of women were asked. Please remember that these were married women and one of the
reasons why people marry is economic cooperation. Therefore, a partner’s economic strength
could have effect on the other.
12. The discussion was not well organised; it should state what gap the study was designed to
fill? What do we know now (short summary of results)? Then, present how the results are similar
to and different from what we know from the literature and nuance this with your conceptual
framework/theory.
13. There was a very forced attempt to dangerously link contraceptive use to ethnic association/
origin. What kind of analysis is that? That the Ga-Dangme use contraceptives more than the
Akan ethnic group (which could comprise Asante, Akwapim, Fanti, Brong, etc.). Really? Which
contraceptives are they more likely to use and why? This analysis constitutes a very sensitive
research design and stereotypical. The fact that data is collected with collaboration between
Harvard T.H Chan School of Public Health and Regional Institute for Population Studies,
University of Ghana does not mean that such analysis is plausible.
14. In the discussion, the paper claims that the study shows the importance of men in women
contraceptive use and the need to include men in family planning programs but no data existed
on men. What then is the basis for this assertion?
15. Other assertions and conclusions are only speculative and they are listed below:
a. In urban poor communities in Ghana, most women perceive that their partners support
them in contraceptive use and this, in turn, is associated with not only women’s actual use of
contraceptives but also with the type of contraceptives they use. This was not shown from the
data.
b. That, the support of husband/men in contraceptive-related choices reduces the likelihood of
women using modern contraceptive methods. Speculative.
c. The support of husband/partners reduces covert use of contraceptives. How?
16. The assertion that women covertly use contraceptives due to husband objection and gender
power imbalance can only be partly factual and this stresses this reviewer’s earlier argument.
Covertly as used here supports my earlier claim that men do not necessarily have control over
some contraception(ive) choices by/of women.
17. The conclusion that the study contributes to understanding the influence of male partners in
women’s contraceptive use was negatively skewed and not factual. It was only based on what
women said and or did not say.
There is definitely the need to straighten the literature for a sounder argument, provide further
details about the data, interrogate the findings a bit more closely, and to nuance the discussions.
It was a pleasure sharing your thoughts with me.
With regards