Reviewer’ s report
Title: Factors associated with induced abortion among women of reproductive age attending
selected health facilities in Addis Ababa, Ethiopia: A case control study.
Version: 0Date: 25 Oct 2018
Reviewer: Diana Taylor
Reviewer's report:
Please include all comments for the authors in this box rather than uploading your report as an
attachment. Please only upload as attachments annotated versions of manuscripts, graphs,supporting materials or other aspects of your report which cannot be included in a text format.
Re: review of manuscript titled "Factors associated with induced abortion among women of
reproductive age attending selected health facilities in Addis Ababa, Ethiopia: A case controlstudy"; MS# BMWH-D-18-00465
Although the topic of this paper is very relevant to affecting evidence-based clinical practice to
improve care for Ethiopian women seeking abortion services, I cannot recommend this paper forpublication consideration without major revisions and editing. Due to the multiple problems withthe paper, I do not have the time to fully comment on all of the specific problems or each of thereview components. Please see footnoted articles which provide proposed standards for abortioncare metrics and outcomes.I would be available to re-review the paper after extensive revision.
MAJOR COMPULSORY REVISIONS
In general, the major problem is in the lack of definition and measurement of the primaryvariable—induced abortion. Induced abortion is not a public health problem it is induced underunsafe conditions or with unsafe medications. Induced abortion under safe conditions or withoutincident is not considered a clinical or public health problem. While it is assumed that the study'shealth facilities provide safe abortion-related services under accepted standards of care, there islittle description of the facilities in terms of abortion outcomes (abortion volume, quality/safetymetrics). However, I commend the authors on the study sampling techniques for reducing bias inthe participant and facility samples.Nowhere in the manuscript are specific variable definitions/descriptions as well as the number ofwomen who received abortions or received care for post-abortion problems:*Type of abortion—by procedure or medication*Gestational age—early, late stage, weeks gestation by LMP or ultrasound*Abortion-related adverse events or morbidity—women receiving abortions and women seekingcare for post-abortion problems (type/severity of incident—adverse event, morbidity)*Previous abortion history—miscarriages, spontaneous/missed abortions, procedural/medicationabortion history*Number of women receiving abortions by procedure/medication, number of women turned away
from receiving an abortion, number of women seeking care for post-abortion problems.
*Women seeking care for post-abortion problems: did they receive the abortion procedure or
abortion medication from the same facility, an affiliated facility, or in an unsafe setting/provider?*Missing from the data collection and results tables are characteristics about the healthcare settingsthat relate to induced abortion outcomes.
1. Standardizing abortion research outcomes (STAR) protocol https://www.contraceptionjourna-
l.org/article/S0010-7824(17)30001-X/fulltext (open access)
2. Standardizing the classification of abortion incidents: the Procedural Abortion Incident
Reporting & Surveillance Framework https://www.contraceptionjournal.org/article/S0010-
7824(17)30136-1/fulltext and PDF
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
NoDoes the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
YesAre 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 furtherassessment in your comments to the editors.
I am able to assess the statisticsQuality of written English
Please indicate the quality of language in the manuscript:
Not suitable for publication unless extensively editedDeclaration 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, funding, 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, write '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 interestsI agree to the open peer review policy of the journal. I understand that my name will be included
on my report to the authors and, if the manuscript is accepted for publication, my named reportincluding any attachments I upload will be posted on the website along with the authors'responses. I agree for my report to be made available under an Open Access Creative CommonsCC-BY license (http://creativecommons.org/licenses/by/4.0/). I understand that any commentswhich I do not wish to be included in my named report can be included as confidential commentsto the editors, which will not be published.
I agree to the open peer review policy of the journal