Reviewer’s report
Title: 
Consanguineous marriages and their association with women’s
reproductive health and fertility behavior in Pakistan: Secondary data analysis
from Demographic and Health Surveys, 1990–2018
Version: 
0 
Date: 
19 Nov 2021
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
OBJECTIVE - Full research articles: is there a clear objective that addresses a
testable research question(s) (brief or other article types: is there a clear
objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols)
appropriate for the objective?
Not sure - key details are missing from the manuscript
EXECUTION - Are the experiments and analyses performed with technical rigor
to allow confidence in the results?
Not sure - key details are missing from the manuscript
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results
reasonable and not overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work
technically sound? If not, can revisions be made to make the work technically
sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: 
Overall, I think the question the paper aims to examine is an interesting one -
identifying trends in consanguineous marriages over time in Pakistan and related
associations. 
The authors do a good job of describing background on
consanguineous marriages in Pakistan as well as describing the data they use. 
I had a few questions that the paper did not address relating to sample weights,
addressing those would be helpful. In addition, the writing could be refined and
made clearer.
REQUESTED REVISIONS: 
Is there any existing literature on consanguineous marriages in Pakistan? 
Lines
62-65 suggest that there is not; if there isn't I would be explicit to say, "To our
knowledge, this is the first paper to examine trends in consanguineous marriages
in Pakistan in recent decades…" as appropriate. 
If there is other work, it would
be important to cite it here and highlight how this paper is different.
Line 93 - missing number of years. Elsewhere in the paper, it describes including
women who gave birth in the prior five years. 
A sentence explaining why five is
the cutoff would be helpful.
Lines 99-101 describe categories of consanguineous marriages including married
to paternal or maternal first cousins and married to relatives other than first
paternal or maternal cousins. Is there a definition for relatives? 
It's unclear to me
how immediate a relative needs to be to be considered a relative.
It wasn't clear to me whether the survey provides sample weights, and if so, if
they were used. Line 121 says, "sample weights were calculated," but I'm not
sure what that means. 
More explanation should be provided. 
I'm concerned that if
sample weights weren't used, differences in estimates over time could reflect
random changes in the composition of the sample.
Line 195 - typo: "omen" should be "women"
Lines 243-244 - To what extent do young girls make the decisions to engage in
consanguineous marriages, or is it their parents that are making those decisions?
ADDITIONAL REQUESTS/SUGGESTIONS: 
Writing should be streamlined.
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