Reviewer ’s report  
 
Title: Unintended Pregnancy and Subsequent Postpartum Long -acting Reversible Contraceptive 
Use in Zimbabwe  
 
Version: 0 Date: 19 Mar 2018  
 
Reviewer:  Made Laanpere  
 
Reviewer's report:  
 
Thank you for tackling this important topic. There is little doubt that decreasing unmet need for 
family planning has a significant positive impact on women's and children´s health, and overall 
health of a communi ty.  I appreciate your efforts to evaluate the trends in pre - and postpartum 
contraception use in Zimbabwe, especially adopting LARC methods and pointing out HIV status.  
The paper is overall well -written and I have very few comments and suggestions that a re both 
general and specific that I hope you will consider.  
Background outlines appropriately the problem investigated, but would benefit if the data about 
LARC methods availability in Zimbabwe were already described there, not in the discussion 
section.  
My main concern regarding the findings in this article is related to LARC methods. LARC 
methods were available only in approximately 60% of the clinics studied (table 1). However, the 
use of LARC methods was studied in all study subjects. In Method section  the third sensitivity 
analysis about LARC availability is mentioned, but not presented in appendix A where data 
about other two sensitivity analysis are presented. It is major limitation and needs clarification.  
Second remark is about presenting disorderl y unadjusted and adjusted data in the results section 
without any reason (page 9). Usually, if adjustment is done, these data considered more reliable 
and theses are worth to repeat in the text.  
Finally, the authors have divided all contraceptive method in to 3 categories: 1) long -acting 
reversible contraception (LARC, highly effective methods that do not rely on adherence, 
including IUD and implants), 2) other modern methods (injectables, pill, condoms or 
diaphragm), or 3) no method or traditional method (r eferent group). For better understanding, the 
first group could be called LARC throughout the paper, because in fact, some contraceptive 
methods like injectables and combined hormonal pills/only progesterone pills are also "very 
effective methods" by WHO ( WHO. Medical Eligibility Criteria for Contraceptive Use. Fifth 
edition, 2015.  
http://www.who.int/reproductivehealth/publications/family_planning/MECguidelinePart -
2.pdf?ua=1 ). 
Are the methods appropriate and well described?  
If not, please speci fy what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects re quire further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration o f competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, eith er now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that 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 inte rests?  
 
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´ below  
 
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on my report to the authors and, if the manuscript is accepted for publication, my named report  
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to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal