Reviewer ’s report  
 
Title: Prevalence and factors associated with modern contraceptive discontinuation among 
reproductive age group women. Community based cross s ectional study in Humera town, 
northern Ethiopia.  
 
Version: 1 Date: 11 May 2018  
 
Reviewer: Mark Weaver  
 
Reviewer's report:  
 
This paper presents a cross -sectional analysis describing discontinuation of modern contraceptive 
methods and factors related with discontinuation among married women of reproductive age 
within one location in Ethiopia. I offer the following comments with the hope that they might be 
helpful in improving the manuscript.  
 
General Comments:  
Although the data described might be of interest by themselves, the interpretation of the logistic 
regression model results  is problematic. The outcome is self -reported discontinuation from 
modern contraception for any reason. A logistic regression model models the probability (via the 
logit transformation) of the outcome within subpopulations defined by the terms within the 
model. That is, in this case, within each subpopulation, discontinuation was modeled as a 
binomial random variable. However, per Table 4, the vast majority of women who discontinued, 
discontinued because they selectively (i.e., not randomly) desired to get pregnant. "Partner 
disapproval" could also imply a desire for more children. Additionally, being in menopause 
implies that women are no longer at risk for pregnancy. Therefore, it's possible that more than 
75% of those who discontinued did so because they were no longer at risk for unwanted 
pregnancy. In this case, it is unclear what would be the value of assessing factors associated with 
discontinuation. Wouldn't the primary factor simply no longer having a desire to prevent 
pregnancy, for whatever reason?  For these reasons, I would strongly recommend removing all of 
the modeling results (Table 5 and all associated text) from the paper and instead focus the paper 
on a descriptive summary of the data.  
 
Specific Comments:  
1. The conclusion in the Abstract is too general (as is line 49 in the Conclusion of the paper). 
These results directly apply only to married women in one city in Ethiopia (from which the 
sampling frame was derived).  
 
2. In the Methods section, please clearly specify the key eligibility crite ria in the manuscript. 
Was there an age range? Were only currently married women included? Were only sexually 
active women included? Did all included women wish to prevent pregnancy? What 
happened in the event of no eligible women present within a selected  household?  
 
3. In "Data management and analysis", having used a condom seems to be counted as having 
used a modern contraceptive method. But couldn't women have chosen to use condoms to 
prevent HIV and other diseases (possibly with partners other than the ir husbands), not 
specifically as a contraceptive method?  
 
4. Despite my above recommendation to remove the model results, if the authors decide to 
present results of probabilistic models, then there are some questions about the modeling 
strategy that shou ld be addressed in Methods. What confounding factors were controlled for, 
as alluded to on line 34 of page 6? Why were they considered confounding factors? If the 
purpose of the analysis is simply to evaluate associations, then why would it be necessary to  
control for confounding? How were these factors selected for inclusion in the models? Was 
kebelle controlled for in the models, since it seemed to be a stratification factor in the 
sample design?  
 
5. In Table 2, it is somewhat surprising that no participa nts had ever used more than one 
method. If any had, how are those results reported in the data?  
 
6. Per Table 3, given varying times of exposure, it is not strictly appropriate to apply logistic 
regression models with discontinuation as the outcome. Instea d, if modeling is to be used, 
survival analytic methods would be preferable. For example, a new user (<= 6 month) might 
only be a current user who has not yet discontinued, so they should not be counted the same 
as a woman who has already used her method f or >= 13 months. At the very least, all 
models should control for duration of use, although this is a sub -optimal approach to 
survival analytic methods.  
 
7. The percentages in Table 4 add to more than 100%, so it needs to be clearly indicated that 
particip ants could select more than one response.  
 
8. In Figure 1, a scale should be provided on the Y axis.  
Are the  methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
  
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.  
 
No 
 
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 manuscr ipt: 
 
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, fund ing, 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, w rite '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.  
 
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