Reviewer’s report
Title:  Experience  obtaining  legal  abortion  in  Uruguay:  Knowledge,  attitudes,  and  stigma  among
abortion clients
Version: 1 Date: 10 Aug 2019
Reviewer: Isaac Mensah Boafo
Reviewer's report:
General: The major strength of this study is the subject of the study. Unsafe abortions accounts for a
significant portion of maternal mortality globally. The major weakness is the methods. The study would
have benefited immensely from a mixed methods design. It would have also benefited from data from
multiple sites.
Abstract: 
Results:  Page2 lines 41-45
Younger women in the sample (ages 18-21) reported more worries about judgment than women ages 22
and older. 
Please provide the statistics to this effect.
Conclusions: Page 2 line 57
To train staff in what kind of skills? You have to be specific because nowhere in your study did you
report that staff involved in the provision of abortion did not have the competence to do that.
Line  58 - Can you  please  be specific in your recommendations, what  kind of community-based
activities should be undertaken? It is better that researchers provide specific recommendations so that
policy makers and practitioners who would want to utilize the study would know exactly what to do.
Background: page 5 lines 10-13
*I don't think this is a good definition, stigma goes beyond being morally wrong and socially
acceptable. It discredits and devalues the person. 
Methods:
*What are the psychometric properties of the scales in the current study?
*How did you ensure that the gifts provided for participants did not influence their participation
and responses? This should be discussed under ethical considerations
Results: 
Page 7 lines 53- 58
*Your results show that some of your participants were lost. What were the implications of this
for your study? I suggest you discuss this in the discussions section.
Page 14
*In lines 18-20 page 14, you  report a statistically significant difference between older and
younger women in relation to "worries about judgment". Then on lines 26-27 on the same page you
indicate there was not significant difference. Can you please clarify this seeming inconsistency?
Discussion:
*Page 17 lines 7-28 How do these findings compare with other studies? What is presented here is
a mere repetition of the results not a discussion.
*Page 18 line 8 - From your results less than a quarter of the women reported feeling judged so
why do you state "Most women in our study expressed concerns about being judged for having an
abortion"?
*Since internalised/ felt stigma was more pronounced than enacted stigma, the authors should
discuss the contextual factors which could account for this. It would be of interest to international
readers, especially when the authors claim Uruguay is a less 'religious' country.
*Overall,  l  feel  the  results  were  not  thoroughly  discussed.  The  authors  presented  more  of
commentaries (opinions) on the results and did little by way of comparing the results with other
studies.
Conclusions: 
*Page 21 lines 5-10 What kind of training do you recommend? Please be specific.
*See previous comments on abstract.
Are the methods appropriate and well described?
If not, please specify 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.
Unable to assess
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  require  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:
Needs some language corrections before being published
Declaration of competing interests
Please complete a declaration of 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, either 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 interests?
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.
The conclusions drawn from the study are adequate but needs some minor revisions to make them more
precise. See attachement
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