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: 
1 
Date: 
25 Mar 2022
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
OBJECTIVE - Full research articles: is there a clear objective that addresses one
or several testable research questions? (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?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with sufficient
technical rigor to allow confidence in the results?
Yes - experiments and analyses were performed appropriately
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 - Has the author addressed your
concerns sufficiently for you to now recommend the work as a technically sound
contribution? If not, can further revisions be made to make the work technically
sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: I suggest further revisions for a few of my previous
comments.
ADDITIONAL REQUESTS/SUGGESTIONS: 
Line 96 - still vague - should read something like, "who had given birth in the
five years preceding each of the four PDHS waves" or "who had given birth in
the three or five years preceding each of the four PDHS waves". 
Since the
sentence begins with "This research…" I would think the first sentence is the
appropriate one, or the beginning of the sentence should be revised to, "This
survey…". It would also still be helpful to include a sentence with why five
years prior (rather than three, if that is the other measure that is available) is used.
Lines 103-104 describe categories of consanguineous marriages including
married to paternal or maternal first cousins and married to relatives other than
first paternal or maternal cousins. It would be helpful to include a footnote to the
point the authors made in their response, that who is considered an other relative
is not defined in the survey. 
Lines 247-249 - Still, to what extent do young girls make these decisions, or is it
their parents/relatives that are making those decisions? I would either drop this
sentence or revise to something like, "This highlights the need to educate and
empower young girls, their families, and communities, enabling them to make
better informed decisions promoting reproductive well-being."
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