Title: Women’s Autonomy and Maternal Health Decision Making in Kenya: Implications for
Service Delivery Reform - A Qualitative Study
Version: 1 Date: 03 Jan 2024
Reviewer:  Solomon Cheboi
Reviewer's report:
Dear editor,
Thank you for giving the opportunity to review the manuscript.
Comments to the Authors
I found the work highly insightful for publication however I have suggested some
recommendations to make the work stronger.
General rubrics
1. There is a tendency by the authors to use long sentence and repeat statements which I suggest
revision
a) The titled is 28 words and a revision in line with study objective may shorten it.
b) Long sentence in example in line12-15, 35-38, 233-235
c) Repetition line 130-134 vs. 139-142
2. Few typos and omission in page 457, 462 and 474
3. Lack of citation in line 60-63; 86-98; 126-129
4. Operationalization of variables is not adequate provided
a. How was high self-esteem measured in this study (line 25)
b. How was good knowledge deduced (line 188)
5. Review of used words
a. The word significant (line 24, 231, 265, 278 and 298 is commonly used in the results and
associated yet this is a qualitative study focusing on cases rather than samples
b. adapted is used in line 18 without a justification on how the conceptual framework was
changed or revised to suit the study context in the manuscript text.
Section reviews
• Abstract- its adequate in form however
o What is the issue with maternal and newborn services in study area (sentence with statistics
on this will suffice)
o Which is the appropriate objective of this study (since line 15-18 and line 130-133 seem not
to speaking to each other)
o Who are in particular are the study participants?  (line 21-23 talks of pregnant women yet men
are part of the FGDs).
• Background- there is a general good attempt to lay a foundation for the study with bias to
long description of women autonomy and International Centre for Research on Women (ICRW)
framework that need to be revised to be concise and focused after being justified. An addition
of (i-iv) would enrich the study background-
i. What are the maternal and child issues in study area with bias to the need for respectful care?
ii. What warranted the intervention (statistics?)
iii. How is International Centre for Research on Women (ICRW) framework relevant to this
context?
iv. The concept of agency is hardly introduced, authors directly start with definition of Individual
agency in line 79
• Methods- this part is well sectioned but with inadequate details
o Study setting- a description of maternal and child issues in general and per sub-county hospital
would suffice
o Study participants and data collection
# The data collection period needs to be restated well
# Who are the study participants (How were the men selected)?
# Provide key details on why FGD, IDI, KII and a small group interview
# Who participated in which interview and why?
# What was the selection criteria
# State the inclusion and exclusion criteria in brief
# Elaborate the interviewing process (were these FGD, IDI, KII sequential or concurrent?)
# Provide difference between FGD and small group interviews in this study context? Number
of participants in FGD and small groups interviews
# How was demographic dynamics (gender, age,) issue handled in FGDs and a small group
interview?
# How where interviews distributed
# What lasted for 30- 60 minutes
# What was the guide quality control mechanism for translation? Was all round translation
undertaken? (From English to Kiswahili and back to English
• Results- the result is satisfactorily presented but in monolithic perspective yet the authors are
endowed with verbatims from 27 interviews.
• Statement stating general theme concurrence across interviews/views (certain interviews)
would suffice
• Verbatim providing concurrence or contrasting views is necessary
• Citation (line 376-378) and discussion (line 366-367) in the result be shifted to the discussion
section
• Discussion-This section needs to be enriched and voice of the researchers be pronounced (for
example, statement like in line 366 need to be part of the discussion)
• Conclusion- The conclusion needs to be revised in line with study 3 thematic focus areas
(distance relational agency, Immediate relational agency and Individual agency) and strong
recommendation made from the specific determinants deduced within each dimension