Title: The use of Method Information Index (MII) to monitor the amount of information given
to women users of modern contraceptives in Indonesia: results from an analysis of the 2007,
2012 and 2017 Demographic and Health Surveys
Version: 1 Date: 01 Apr 2022
Reviewer's report:
The article entitled “Informed choice, the target 3.7 of the sustainable development goals
(universal access to family planning information and education): an analysis of the 2012 and
2017 Indonesian Demographic and Health Surveys” seeks to measure the percentages of women
making an informed choice of contraceptives and associated factors in Indonesia between 2007
and 2017, and to examine women characteristics that increase the likelihood of making an
informed choice.
The topic chosen by the authors for their research is currently high on the international agenda.
An example of this is that this research is framed within the framework of the Sustainable
Development Goals (SDGs). Results show that more efforts are still needed to ensure that
women have informed access to contraceptives. Indonesia is a country that is slowly converging
to the replacement rate, which reflects the slight increase in contraceptive prevalence in recent
years.
Moreover, the manuscript is easy to follow and present the results clearly.
However, I consider authors should address some issues:
Main remarks
1. Authors select five modern methods: female sterilization, implants, injections, IUD and the
pill. It is not clear to me why they choose only these methods. The DHS provide an exhaustive list
of methods. Moreover, other studies – that are cited in this research – include additional methods:
male/female condom and emergency contraception. Since female sterilization is included, why
is not male sterilization included? In fact, I do not know to what extent sterilization should
be included in this study since it is not a method that can be discontinued (or at least easily).
Moreover, I do not know whether one could speak of side effects inherent to the method but
rather complications of the surgery.
Moreover, the authors comment in the Limitation section that the MII values correspond to
information collected from five contraceptive methods. This means that the limitation of the
study arises due to a decision of the authors. I recommend that the authors justify the selection
of the methods they analyze.
In addition, authors state in the Limitation section that further research on MII plus should be
carried out. And I wonder, why are not the authors doing it? This will add value to the study and
make it more robust. I encourage the authors to include this in the paper.
2. The study uses two DHS, 2012 and 2017. However, DHS are collected in Indonesia since
1987. Why do not the authors analyze a longer period? Authors should explain why they are
focusing only in these two surveys.
Should the authors decide to continue using only these two surveys, they should note that one
of the improvements of the 2012 and 2017 DHS is that information on never-married women
is also collected. Authors could use all sample – not only married women – and include marital
status as explanatory variable.
3. Authors state “The bivariate associations between informed choice (MII scores) for
contraceptives and the characteristics of the women were conducted using logistic regression
analysis, and those characteristics that were statistically significant were retained and entered
into a multivariable logistic regression model”. This method is inaccurate. Variables should be
kept in the models not because they are significant but because they contribute to explaining/
controlling the effect to be estimated. The variables included in a model must be supported by
theory/previous findings. Perhaps the authors should explain their model better to understand
why they have included the covariates they have included.
In addition, I recommend to present results from both bivariate and multivariate regressions.
4. One of the most salient findings is that younger women are less likely to be correctly
informed about contraception. The SDGs include specific indicators on adolescent sexual and
reproductive health and on the importance of meeting their contraceptive needs. I recommend
that the authors further discuss this particular finding.
Minor remarks
1. In the Introduction and Discussion sections, the authors state that they are analyzing a ten-
year period, 2007-2017. However, they use the 2012 and 2017 DHS, which do not cover a ten-
year period, but a five-year period.
2. Authors should specify whether they are using married women or in-union women, which
would be a larger group than married women.
3. The paragraph on page 5 beginning with “Figure 1 describes the distribution of MII values...”
is irrelevant. Authors present as a result that half of the provinces are above the average and half
of the provinces are below the average. Of course, that is how the average works. I recommend
using that paragraph to highlight the provinces with higher/lower MII values, and whether those
provinces are the same ones with higher/lower levels of contraceptive use.
4. Place of residence is missing in Table 3 and in the analysis.
5. Authors state that in all analyses a p-value less than 0.05 is considered statistically significant.
However, in Table 3 p-values are p<0.001 and p<0.01.
In fact, the results presented in Table 3 could easily be presented in a graph. Personally, I find
the ORs and AORs much easier to interpret/understand in a graph. The results of the bivariate
regressions could be included in the same graph.
6. Authors constantly refer to Ethiopia when presenting and discussing the results. Why? Is
there a particular reason to do it? Are Indonesia and Ethiopia comparable? If so, authors should
explain this. There are findings for other countries but only Ethiopia is explicitly mentioned.
7. Authors find that better educated women and wealthier women are more likely to be better
informed. The authors should further discuss that the evidence shows that education and wealth
are correlated with greater access to health care. Also, that the cost of modern contraceptives
can be a barrier for women in more depressed socioeconomic situations. Both increased access
to health services and barriers to access to contraceptives affect the information women receive
about contraceptives.