Reviewer ’s report  
 
Title: Modern contraceptive use among reproductive -aged women in Ghana: Prevalence, 
predictors, and policy implications  
 
Version: 1 Date: 27 Jun 2018  
 
Reviewer: Albert Opoku  
 
Reviewer's report:  
 
The authors aimed to assess the prevalence and  predictors of modern contraceptive use in an 
urban setting in Ghana. They should be commended for their efforts though the paper needs 
several amendments as discussed below. I have also attached the manuscript with some minor 
typographical and grammatical  correction/suggestions.  
With respect to the study design - some more detail about the assumptions used for the sample 
size calculation would be useful for assessing how representative the sample is. Also, what 
percentage of the municipal area's 500,000 po pulation are women of reproductive age group?  
The study instrument was in English and was administered by trained interviewers - was any 
adjustment made for illiterate/semi -literate participants (8% and 13% of study population were 
either uneducated or had primary level education)?  
11% of the study population were aged 15 -19 years. It is unclear from the paper whether these 
are the ones referred to as minors who had parental consent to take part in the study? As this 
study focuses mainly on the contraception , I daresay minors in Ghana are much less likely to 
answer correctly as this implies sexual activity, which will be generally not openly alluded to in 
the typical Ghanaian society. This may be evidenced by the fact that no one in this age bracket 
acknowled ged use of contraceptives.  
It is also unclear whether all the study participants were sexually active at the time of the study, 
necessitating the use of contraception.  
 
Results and Discussion  
The discussion makes many assumptions and draws conclusions that cannot be evidenced from 
the results of the study. Is the 21% overall prevalence of contraceptive use significantly lower 
than the national target of 23.3%, or a true reflection of contraceptive use in the country; as per 
the national health survey (22%)?  
Some of the variables used to predict contraceptive use are not clearly defined for the purposes 
of this study - knowledge, awareness, positive attitude, religious influence. In my opinion, these 
multi -factorial and contextual variables will be better asses sed by qualitative analysis. Having 
said that, the calculated odds ratios and confidence intervals for 'knowledge and awareness' and 
'religious influence' [0.8 (0.1 -7.9) and 0.4 (0.2 -0.9) respectively; cannot be interpreted as highly 
significant.  
Compariso ns are made with Iran, which has a higher prevalence of contraceptive use and the 
difference is attributed to a better national education program for family planning and population 
control. This contradicts the fact that 98% of the study population had 'ad equate' knowledge of 
modern contraception methods (did not lack education) and the fact that there was a non -linear 
correlation between knowledge/formal education and contraceptive use.  
Being married and partner support were found to be strongly associate d to contraceptive use. 
Such comparison with unmarried women/women not in relationships, who may therefore not be 
sexually active, potentially introduces some bias. There's a mention about a predominantly 
traditional patrilineal society to explain the infl uence of partners on contraceptive use - the 
authors should be well aware that many tribal systems in Ghana actually have a matrilineal 
system of inheritance. Guess they meant patriarchal.  
The influence of religious beliefs was also found to be a significan t predictor of contraceptive 
use. This will also benefit from further explanation as 87% of the study population were 
Christian - presumably with same religious beliefs.  
The recommendations made by the authors for the development of reproductive health edu cation 
and family planning programs in the various Ghanaian languages to target non -literates has no 
bearing in the study findings as there was no association between formal education and 
contraceptive use and literacy was not one of the variable assessed.  The second recommendation 
to target male partners, due their influence, can also not be directly inferred from the study. 
There's also a recommendation that efforts should be made to dispel misinformation, 
misconceptions, wrong religious beliefs and myths  which cannot also be evidenced from the 
study.  
Are the met hods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
  
Are the co nclusions 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.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
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, fee s, 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  
financiall y 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 organizati on 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 a bove, 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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