Title: Women’s involvement in decision-making andassociation with reproductive health
behaviors: Findings from a cross-sectional survey in Niger
Version: 2 Date: 06 Sep 2023
Reviewer's report:
Dear Editor,
Thank you for the opportunity to review the manuscript entitled “Women’s involvement in
decision-making: association with reproductive health behaviors and correlates of involvement
in health decision-making in Niger”. I found the study interesting and very timely. However, I
have provided some comments that if the authors consider may improve their manuscript. These
comments are detailed below. Apart from that, the authors are strongly encouraged to fill out
the STROBE checklist and attach it as a supplementary file.
Best wishes.
Abstract
1. This CI [aOR:1.34 (95% CI: 1.0)-1.79)], shows that this is not significant. Kindly modify this
accordingly. I have also commented on this at the results section of the main paper.
2. This statement “There was no significant association between involvement in decision-
making and skilled birth attendance at recent delivery” can be removed since it is not statistically
significant
3. The conclusion “Social and behavior change strategies to shift social norms and increase
opportunities for women’s involvement in household decision making are needed”. This is a
great suggestion, but can you please be more specific on the type of SBC?
Background
4. Great background and review of pertinent literature. Can you please also situate this within
the sustainable development goals. Especially goal 3?
5. Situating the study  within reproductive empowerment (16) and socio-ecological frameworks
(17) is a great strength of the study
Methods
6. It will be a great idea to add a map of the study sites
7. Table 1 Why didn’t you use the WHO new ANC model of at least 8 visits
https://www.who.int/news/item/07-11-2016-new-guidelines-on-antenatal-care-for-a-positive-
pregnancy-experience. Strong justification is needed for this.
8. You referred to “Household socio-economic status” as wealth in Table 1, please check
Results
9.  “Respondents’ involvement in decision making was also associated with increased odds of
four or more ANC visits during her recent pregnancy [OR: 1.30 (95% CI: 0.98-1.72); aOR:
1.34(95% CI: 1.00-1.79)] compared to those who were not involved in household decisions
about making a large purchase, visiting her family/parents, and decisions about her own
healthcare”. Please these are all not statistically significant
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2689604/
https://sphweb.bumc.bu.edu/otlt/mph-modules/ep/ep713_randomerror/
ep713_randomerror6.html https://www.mja.com.au/journal/2021/214/3/why-proper-
understanding-confidence-intervals-and-statistical-significance
10. Table 4 “Although the p-value for ANC indicates that this is marginally significant, but if
you check the confidence intervals(95%CI=1.00-1.79) it is not statistically significant–the lower
bound is exactly 1.00. I will therefore entreat you to modify the reporting of the findings and
its related discussion. Thank you.
Discussion
11. Although the authors situated their study within given frameworks, but these were never
mentioned or discussed in the discussion section. Please try incorporating that into the
discussion.
12. It is also important to revise the discussion since the association between RH decision and
ANC isn’t significant.
13. The authors have done a great job by discussing the limitations inherent in their study. It
will also be good to discuss the strength of the study.
14. This statement requires a reference(s) “Finally, as seen elsewhere, partner communication is
an important aspect of women’s involvement in decision-making that our data did not measure
and therefore our analysis could not explore; future work…”
All the best!