Reviewer ’s report  
 
Title: Eliminating the high abortion related complications and deaths in Cameroon. The 
restrictive legal atmosphere  on abortions is no acceptable excuse.  
 
Version: 1 Date: 24 Mar 2017  
 
Reviewer: Erin Pearson  
 
Reviewer's report:  
 
This paper makes the case that despite the restrictive abortion law in Cameroon, high maternal 
mortality from unsafe abortion could be reduced by increasing access to family planning and 
postabortion care (PAC), especi ally for adolescents.  
 
Major comments:  
1. It would be helpful to state your arguments more clearly. Right now the body of the 
manuscript reads as a list of facts about Cameroon without much clarity on the arguments or 
enough synthesis to support your arg uments. I would recommend making your key 
arguments at the beginning of each paragraph, and then using the literature to support your 
arguments. Some of the information such as the CPR and TFR in line 21 on page 7 should 
probably be moved to the Introducti on. 
 
2. Additional work is needed to improve the organization of the manuscript. For example, the 
paragraph under "Abortion and family planning services" includes information on family 
planning, adolescents, and sex education in Cameroon, but does not incl ude any information 
on abortion. The section on "Abortion care and the law" is better organized, and it is great 
that you have added more information on misoprostol use. You might want to break this 
section into multiple paragraphs. The first paragraph cou ld be on the law, the next on PAC 
generally including postabortion contraception (it would be helpful to add more information 
about PAC service availability in Cameroon - at what levels of the health system are 
services available? Are they available throug hout the country or only in urban areas), the 
next on MVA (including training needs), and the last on misoprostol.  
 
3. The abstract states, "The stigma and restrictive legal status around induced abortions in 
Cameroon mandate a heightened level of clinical  suspicion among sick women of 
reproductive age when received in health facilities, because they might not generally present 
with classical signs and symptoms of incomplete abortions, and might fail to disclose any 
induced abortion attempts to hospital sta ff." This statement seems too detailed to be in the 
abstract, and this issue is not discussed in the body of the manuscript (only the Conclusion). 
I would recommend moving this information to the body of the manuscript if it can be cited, 
and including a s ummary statement about stigma in the abstract instead.  
 
Minor comment:  
1. Affiliation 3 (UNFPA Abuja) has not been assigned to an author on the title page. Please 
add the superscript 3 to the appropriate author's name.  
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 required in your comments to the authors.  
 
Yes 
 
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 t he manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of  written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable for publication unless extensively edited  
 
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, 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 share s 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 rece ived 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 interests  
 
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