Reviewer's report 
 Women and Postfertilization Effects of Birth Control: Consistency of Understanding, Beliefs, Title: 
Intentions 
 1  31 May 2005 Version: Date: 
 Melanie Gold Reviewer: 
Reviewer's report: 
1. Is the question posed by the authors new and well defined? Yes, the question is new and it is well
defined. However, the background of the paper (and the discussion) sounds like they were written for another paper about womens understanding, beliefs and intent to use different forms of birth control. The main goal of this paper, per the authors, is to assess the consistency of responses of 
subjects who answered a survey about their beliefs and understanding of how methods of 
contraception work. Thus, the background should review the literature on response consistency in 
survey research as well as discuss why this is important for this particular topic and in a clinical setting. The entire argument of the paper is for enhancing womens knowledge about how birth 
control methods work but without fully reviewing prior research in response consistency, what it 
means and why it is important. 
2. Are the methods appropriate and well described, and are sufficient details provided to replicate 
the work? There is not enough detail on the pilot-testing of the survey or regarding any waivers of 
written or parental consent in the methods section. 
3. Are the data sound and well controlled? They are sound. The issue of control is not applicable to 
this survey study. 
4. Does the manuscript adhere to the relevant standards for reporting and data deposition? Yes. 
5. Are the discussion and conclusions well balanced and adequately supported by the 
data? No. The discussion should include much more about how the authors data on response 
consistency compares with other research in the literature on response consistency. The conclusion 
does not address how consistency of response from the authors data relates to the authors 
conclusions. 
6. Do the title and abstract accurately convey what has been found? No. The title is clear 
and appropriately informs the reader that this is a study about consistency of responses on a survey. 
However, the abstract results are presented in an order that makes the reader think that this paper 
will focus on subjects beliefs and intents when the paper is really entirely about the consistency of 
subjects responses. The abstract would more accurately represent the paper if lines 1-4 of the 
results section were moved to the end of the results section instead of leading the paragraph. 
7. Is the writing acceptable? Yes. It is written in clear English 
Detailed comments for Authors 
Pages 4 and 5: The background of the paper (and the discussion) sounds like they were written for a 
different paper presenting results of womens understanding, beliefs and intent to use different forms 
of birth control. The main goal of this paper, per the authors, is to assess the consistency of 
responses of subjects who answered a survey about their beliefs and understanding of how 
methods of contraception work. Thus, the background should review the literature on response 
consistency in survey research as well as discuss why this is important for this particular topic and in 
a clinical setting. The entire argument of the paper presented is to enhance womens knowledge 
about how birth control methods work but the authors do not provide a review of prior research in response consistency, what it means or why it is important. 
Page 4, Background section, paragraph 2: the term clinically recognized pregnancy is not clear in 
the context of this sentence and should be clarified. 
Page 4, paragraph 3, line 4: there should be a comma between personal and moral 
Page 5, Methods section: last paragraph, lines 4 and 5: should the term personal opinion be called 
beliefs? 
Page 5, paragraph 1-3: Can the authors please clarify that the questionnaire from which the data for 
this paper was obtained was a self-administered survey (versus a face to face interview)? This is 
somewhat confusing throughout the paper. Also, how long did it take subjects to complete the survey? 
Page 5, paragraph 1 - 3: Can the authors provide more information regarding how well subjects 
understood the staging terminology (either based on their pilot testing or this survey study)? More 
detail would be helpful in paragraph 3 where the authors refer to a work under review (reference 15). 
How old were the 21 patients in Salt Lake City who pilot tested the survey? When was this survey 
conducted? Will the authors make this survey available upon request via this journal? 
Page 7, paragraph 1: The authors mention the religious affiliation of the organization. This could be 
more fully discussed in the discussion section as a potential bias of the population (although the 
authors did discuss the limitations of generalizability of their findings in the discussion) 
Page 7, paragraph 2: The authors refer to study researchers presenting the questionnaire to 
subjects. Again please clarify if this was a self-administered survey or a face to face interview. What 
was the gender and background of the study researchers? Where they doctors, nurses, research 
assistants? 
Page 7, paragraph 2: For subjects who were minors, was there a waiver of parental consent or did 
their parents have to give written consent? For all adult subjects, was written consent obtained to participate or was this waived? 
Page 7, Statistical Analysis section, paragraph 3, line 3: there should be the word of between the 
words methods and birth control and the second methods should be deleted. 
Table 1: Why were birth control methods used currently combined with future birth control methods 
in table 1 - these seem like two different levels of behavior (one is current use and the other is intent 
to use). Why were the transdermal patch and the vaginal ring not on the list of methods? When was 
this survey done? Pre-2002? 
Pages 9 and 10 sentence structures for these pages of results are very complex and were often 
times confusing requiring multiple readings of each paragraph. Can these be simplified at all? 
Page 11, paragraph 2, last line: the word nor should be changed to or 
Page 12- 16: the discussion should include how the authors data on response consistency 
compared to the literature on response consistency. 
Page 13, paragraph 1: It would be helpful if the authors would address how women should be 
educated about the mechanism of action of birth control methods in light of the fact that it is often 
unknown what percentage of the time each method works by each stage. 
Page 13, paragraph 2, line 5: change the word whats to what is 
Page 15, paragraph 2: The authors should cite references to support their claim that it is the role of 
the package insert to educate women about early stages of human reproduction. This is controversial (though not presented as so by the authors). No other medications are expected to educate consumers about, say, the gastrointestinal system or the nervous system in the cases of 
medications such as H2 blockers or SSRIs. It is unclear why the package inserts of contraceptive 
should have a different role than that of other medications. Especially given that the exact 
mechanism of action of many contraceptives is not clearly know (in terms of % of time working at 
different stages). 
Page 16, paragraph 3, line 5: The authors say filling out the questionnaire here but it would help in 
the methods section to clarify that this was a self-administered survey. 
Page 17, Conclusion: How is consistency of response from the authors data related to this 
conclusion? 
Page 18, reference 15: please add t to title of word posfertilization 
Table 1: What were the patch, ring and natural family planning not included in the table? It would be 
helpful to include the n of the sample size so the table can stand alone. Why are 95% confidence 
intervals relevant here? 
Table 2: Since the title of the table is Personal Opinion of What Stage a Birth Control Method May 
Act, why are abortion, RU-486 included in the table since they are not birth control methods? These 
should not be in a table labeled such or the title should be revised to more accurately reflect the 
variables. The sample size would help this table to stand alone. 
 Unable to decide on acceptance or rejection until the authors have responded to the What next?: 
major compulsory revisions 
 An article of importance in its field Level of interest: 
 Acceptable Quality of written English: 
 Yes Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interests