Reviewer’s report
Title: 
Barriers to seeking post-abortion care in Paktika Province, Afghanistan: a
qualitative study of clients and community members
Version: 
3 
Date: 
28 Aug 2021
Reviewer's report:
I hope very much that the authors and their colleagues working in Afghanistan
are safe, and either able to remain in Afghanistan safely or if it is their
preference, to have gotten out. This work is going to be one of the few pieces
that come out of Afghanistan considering it is likely going to be impossible to
collect data there for the foreseeable future. This increases the value of these data
greatly. The recent deterioration of conditions in Afghanistan should be
acknowledged in the conclusion; the authors may also need to give a think to
whether their recommendations still make sense. 
Pg. 3, line 7: "address PAC-related..."—if that's the 5th component of PAC that
may be conducted by mid-level providers, then it should be "addressing" (and
the "and" should be removed from the line above).
Pg. 3, line 29: add "and provision of" before "post-abortion contraception"
because it's not treatment of post-abortion contraception.
Pg. 3, line 31: "the EmONC study" - it has not yet been introduced so readers
don't know what the EmONC study is. 
Pg. 4, line 6: "reported [ever? currently?] using a contraceptive method"
Are women supposed to first go to a clinic before they present at Sharana
Hospital (see bottom of pg. 8), i.e. do they need the referral from a lower level
facility before they can be admitted to Sharana? Is so, this should be specified.
This quote, "My husband and I consulted with each other that the hospital is
good and it's better to do the cleanup. (35 year old PAC client)" does not
represent male accompaniment, the section in which it appears. 
Pg. 18, line 60: there is a gratuitous semi-colon before the period.
"Increasing the number of health facilities that can provide basic EmONC,
including PAC, by extending services to where mid-level providers are based, is
one way to reduce distance barriers [12, 34]." They provided no evidence that
women couldn't get care at lower level facilities.
Pg. 19, line 18: "at overcoming distance barriers" as well as getting women to
care sooner.
Pg. 19, line 49: not "despite," but rather "Using the"
Pg. 20, line 56: "dispel rumors of poor quality"—must clarify "poor quality
care," otherwise it reads as though the rumors are of poor quality. (Or is that
what the authors actually mean to say? if so, that's a strange way to describe the
rumors)
Pg. 21, line 11: "increased utilization" add "of health care." 
Pg. 22, lines 24-27: "to determine which opinion seemed to more accurately
reflect their views" - "and made sure to only report on those opinions"? 
Pg. 22, line 29: "communities living"—Communities are "located" in,
communities do not "live" in…
The authors' contributions would be easier to follow if the initials were provided
in the same order as authorship order; similarly, author's information (see end of
the manuscript). (And if only some authors' information about place of
employment is included, perhaps better to just eliminate it entirely as it is
optional anyway?)
If the data quality are low (especially with the IDIs), they are still worth
presenting because of how difficult it is to collect data in this setting. But this
should be acknowledged by the authors.
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