Title: Relationship between classic indicators of health behaviour and contraceptive choices in
women in Flanders
Version: 1 Date: 17 Feb 2024
Reviewer's report:
The authors of the manuscript "Relationship between classic indicators of health behaviour and
contraceptive choices in women in Flanders" have aimed to "...to investigate the association
between socioeconomic status, health behaviour and detailed contraceptive choices in Flanders,
Belgium using recently collected data within the framework of a large-scale citizen science
project, named Isala...".
The research question is worth of studying, since a recent trend of less hormonal contraception
usage has emerged in many developed countries and as the authors very clearly point out in
the Background paragraph: "... the trend towards abandoning hormonal or contraceptive use
altogether is particularly visible in advanced economies and within the group of highly educated
women".
The manuscript is written in understandable English.
The sample size is sufficiently large.
Before considering the manuscript to be published, the following minor issues should be
addressed:
1. Page 6, Methods paragraph (Measures. Contraceptive use) the Authors have defined the
usage of "no or non-modern methods" as " Non-modern methods, also referred to as ‘traditional
methods’, including coitus interruptus, periodic abstinence, fertility awareness based method/
natural family planning, lactation amenorrhea (LAM). Non-use includes using no contraceptives
as well as emergency method (morning after pill; this is an emergency method and therefore not
consistent contraceptive use)".
At the same time there is evidence that using for example FDA approved Fertility App Natural
Cycles among others has proved to be comparably efficient as pill use:
https://pubmed.ncbi.nlm.nih.gov/33370220/
https://pubmed.ncbi.nlm.nih.gov/30880509/
https://pubmed.ncbi.nlm.nih.gov/30904873/
Demographic analysis of the app users in UK shows that, indeed, 83% of the fertility app users
had a university degree or higher:
https://pubmed.ncbi.nlm.nih.gov/33539252/
This paradox – fertility apps are classified by the Authors as traditional methods, equal to no
method used, and at the same time these apps are used by educated women with high efficiency
– should be addressed and elaborated further by the Authors.
Preferably commented in the Methods paragraph and in the Discussion paragraph.
2. Did the study include only heterosexual couples/women? This is not clear from the
relationship status definition (page 8, Covariates paragraph).
3. The titles of the tables 1,2,3 should be presented in the way that the reader understands the
content of the table without reading the whole article. All the three titles have to be rephrased
accordingly.
Author guidelines https://bmcwomenshealth.biomedcentral.com/submission-guidelines/
preparing-your-manuscript#preparing+tables: Table titles (max 15 words) should be included
above the table, and legends (max 300 words) should be included underneath the table.
4. Abbreviation SES should not be used in the table (write instead "socioeconomic status"), in
the case an abbreviation is used, there has to be an explanation underneath the table.
The same concerns abbreviations HPV and LARC, RRR, RRR, P>|z|, conf, int., SD, N.
5. The column headings in tables 2 and 3 are not clear – should be explained (for example
"conf" and "int." are in different cells - what do you mean here? 95% confidence interval??? or
something else? why in different cells in the table?):
RRR
P>|z|
conf
int.
The same concers Table 1, the last column heading is confusing:
SD
N
6. Please mention in the Methods paragraph which software tool was used to perform logistic
regression analysis.