Reviewer ’s report  
 
Title: Texas women ’s decisions and experie nces with self -managed abortion  
 
Version: 0 Date: 12 Nov 2018  
 
Reviewer: Lisa Haddad  
 
Reviewer's report:  
 
This is an important paper that utilizes mixed methods to understand the motivations for and 
experiences of women attempting self -managed abortion in Texas. This is a challenging area of 
research with limited quality data. The thoughtful multipr onged approach helps to highlight 
some of the challenges plaguing the reproductive health care provision in Texas. While the study 
has limited generalizability, it still highlights important details of women's experiences that 
deserve attention. Some speci fic comments/suggestions below.  
 
Background:  
 
- A nice background on the laws in Texas  
 
- Citation needed for statement about added burden post HB 15 - lines 101 -102. 
 
 
Methods  
 
- Any reimbursement for survey - please put in methods  
 
- How many individuals were  eligible for participation at the clinics during time frame you 
administered survey? Would include number approaches and those participated to get an 
idea of selection bias  
 
- How many individuals did you contact for qualitative interviews to reach 18  
 
 
Resu lts: 
 
- Line 217 - remove not show as you report the data  
 
- Table 1 - can include year (2012 and 2014) in the table as a category  
 
- Would like to more about distribution of patients for survey - what proportion came from 
which clinic and gestational ages - were they similar by attempted self -induction.  
 
- You do not consistently note language of interview - would do so or give some info on 
source for quotes (24 yo LRGV, Spanish)  
- The comparisons with prior to and after more restrictive laws is not strong and do es not 
seem to be associated with the findings reported - would suggest a table with description 
of qualitative interview participants then can reduce text by cutting lines 197 -209 
 
 
Discussion  
 
- Other limitations include potential fear of disclosure during the questionnaire thus 
possible underestimation. Please add this as a limitation  
 
- Your data does not show any increase in self -induction during the timeframe between 
2012 and 2014 - could there be reasons? I do not think the methodology of your study 
woul d be able to capture this. High success rates of misoprostol coupled with possible 
increasing knowledge and availability of misoprostol may lead to a shift in the population 
of those presenting who have failed self -induction. Please add more in to discussi on. 
 
- Line 449 - would specifically highlight many limitations that restrict generalizability  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are req uired 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.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recom mend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate th e quality of language in the manuscript:  
 
Acceptable  
 
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, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat 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 have no competing interests  
 
I agre e to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website alo ng with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named repo rt can be in cluded as confidential comm ents 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal