Reviewer’s report
Title: Why do they take the risk? A systematic review of the qualitative literature on informal sector  
abortions in settings where abortion is legal
Version: 1 Date: 21 Dec 2018
Reviewer: Rachel Jones
Reviewer's report:
It's very inconvenient to put the pages of a paper back together when there are no page numbers. Please  
include them on all your papers in the future. 
The paper is improved. However, the authors still overemphasize the dangers posed by informal sector  
abortions. For example, the authors should not problematize the fact that a majority of abortions in  
India occur outside a formal health care setting. Women's ability to obtain mifepristone at a pharmacy  
makes it much more convenient than having to make one or more doctor's visits. While the OTC  
system in India has problems (for example, enough information is not provided to women taking mife)  
it is a practice that all countries should aim for (and aim to improve). You can make the argument that  
ISAs in a setting where it is legal increases the likelihood that the abortion will be unsafe use, or that  
the woman will be punished, but it is not unsafe by default.  This outlook needs to be reflected in the  
Introduction and the Discussion. 
I would also discourage using "illegal" and "informal sector" interchangeably. I do know that in the  
United States, informal sector abortions are not necessarily illegal in some states. 
I'm not sure the inclusion of Northern Ireland is appropriate, most countries where it is "outlawed"  
allow for exceptions. Admittedly, I did not look up all the other countries in the study and would hope  
that they have somewhat liberal laws (as opposed to only allowing abortion in cases of rape, incest or  
life endangerment). 
The authors misinterpreted the statistic from the Singh et al. study of abortion in India, they estimated  
about 25% took place in a health care facility (not 10%). 
In the Discussion you relate that ISAs were widely reported in high and low-income countries, but the  
study doesn't demonstrate this. For example, the studies cited for the US do not indicate ISA to be  
widely reported. 
A shortcoming of the study is that relevant search terms were not included: self-abortion, self-managed  
abortion. 
The table needs to provide the country for each citation and information about which # it is in the  
references. 
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.
Unable to assess
Are 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  further  
assessment in your comments to the editors.
Not relevant to this manuscript
Quality of written English
Please indicate the quality of language in the manuscript:
Acceptable
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