Reviewer's report
Title:Violence against women and unintended pregnancies in Nicaragua: a
population-based multilevel study
Version:1Date:7 January 2014
Reviewer: Kathleen Franchek-Roa
Reviewer's report:
In this article, the authors aim to measure the association between individual and
community exposure to different forms of violence against women and
unintended pregnancies.
Strengths include that the paper is well-written. I congratulate the authors on
tackling this complex issue and presenting their results in a clear and
comprehensive manner. The concept of ‘controlling behaviors’ exhibited by
perpetrators of intimate partner violence (IPV) and its impact on the health and
well-being of victims is sometimes difficult to quantify and describe, but is an
underlying mechanism in many cases of IPV. The fact that the authors were able
to incorporate this aspect of abuse against women into their study is
commendable and valuable in contributing to the IPV literature.
The specific aims of the project are well-described and the rationale for the study
is laid out well in the background section. Their knowledge and use of the
literature in this area of VAW is comprehensive and current. The methods and
analyses to answer their specific aims are appropriate and well-characterized.
The Results are presented in an ordered fashion, making it easy for the reader to
follow. The Discussion section is well thought out and supports and explains their
findings in a logical manner. The Limitations/Strengths section addresses the
limitations in a thorough, thoughtful manner and emphasizes the strengths of the
study quite well.
Specific Comments:
1) Abstract:
a) Minor Essential Revision: In the Background Section 2nd sentences: “Women
are also often exposed to violence and controlling behavior by their current or
former partners.” Minor grammatical error—should read: “Also, women are
often…”
b) Discretionary Revision: In the Results section, the statement regarding
“Women who lived in municipalities in the highest tertile of controlling behavior by
a current partner…” the reader might benefit from a little more explanation of the
category of controlling behaviors and municipalities.
2) Background:
a) Discretionary Revision: “It has been estimated that in 2008 alone four out of
ten pregnancies that occurred worldwide were unintended.” Would delete ‘alone’
and say, “It has been estimated that in 2008 four out of ten…”
3) Methods:
a) Minor Essential Revision: Univariate, bivariate, and multivariate statistics were
used to describe the data. Sampling weights were introduced in the bivariate
analyses to compensate for the women’s unequal selection probability due to the
sampling method used to collect the data (26).” The reference 26 should be in
brackets not parentheses.
4) Results:
a) Discretionary Revision: The first sentence, “In total, 24% of the pregnancies
were reported as mistimed, 13.5% as unwanted, and 37.1% as unintended.” it is
unclear that ‘mistimed’ and ‘unwanted’ pregnancies are a subset of ‘unintended
pregnancies.’ It appears that there are 3 different categories of pregnancies,
unintended, mistimed, and unwanted. Authors should clarify.
b) Discretionary Revision: Under the sub-heading ‘Municipality-level
characteristics’ it is unclear what the term ‘observations’ implies. Is it the number
of people sampled in that municipality? It might help the reader if the authors
defined this.
5) Discussion:
a) Discretionary Revision: One of the findings in this paper seemed
counterintuitive regarding contraceptive use. “Women who reported unintended
pregnancies …reported having used modern contraceptive methods (Table 1, p
<0.05).” It would be helpful to hear the authors’ comments on why women who
were using contraceptives were more likely to have an unintended pregnancy.
b) Minor Essential Revision: “Thus, is possible that the different VAW measures
used in this paper are an underestimation of the true prevalence.” This sentence
should read, “Thus, it is possible…”
6) Table 1:
a) Discretionary Revision: The title of the table: “ Table 1. Demographic
characteristics of the women in this study (n = 5347) and their exposures to
different forms of gender-based violence stratified by the occurrence of
unintended pregnancy. Weighted percentages are shown.” In the title of the
table, the authors change from using their term of Violence against Women
(VAW) to ‘gender-based violence.’ In general, these 2 terms mean the same, but
there are slight variations in the meaning so I suggest that the authors should be
consistent with their terminology. This is the only place that I could find in the
paper where the term ‘gender-based violence’ is used.
b) Minor Essential Revision: The category ‘Controlling behavior by current
partner (yes)*’ the percent given in the ‘Unintended Pregnancies Column – No’ is
a typo: 47.5.2
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests.