Reviewer's report
Title:Voluntary family planning in association with the paradoxical situation of
high use of contraceptives and abortion in Viet Nam: a cross-sectional study
Version: 1Date:6 February 2012
Reviewer: Jennifer Smit
Reviewer's report:
Reviewer's report
-----------------
This paper examines the association between receiving voluntary family planning
services and abortion in Viet Nam. The data are interesting and the research
constitutes a useful contribution to the field. It is recommended that the authors
respond to the major compulsory revisions detailed below, before the paper can
be considered for publication.
- Major Compulsory Revisions
1. The authors should consider revising the Title: The use of the words “in
association with” is misleading, since no statistical association was found.
Further the title needs to reflect that it is receipt of VFP services, rather than VFP
per se.
2. Abstract, end of Background Section: it is stated that “….. more likely to
continue using contraception” – was this investigated? If so, this should be
reported in the results section. This issue is also raised in the discussion “… will
influence continued use of women’s preferred contraceptives”, please provide
details of results that support this conclusion. For instance, what were women’s
preferred contraceptives.
3. Abstract, Conclusion Section. The assumptions made about the reasons (e.g.
low motivation of health workers) for the lack of lower abortion rates amongst
those receiving VFP should be better justified by means of study findings. This
applies to the conclusions in the abstract and in the discussion of the paper.
4. Background: last paragraph: how were “positive experiences” of receiving VFP
measured in this study?
5. Methods: Can the authors explain the rationale behind categorizing
contraceptive users into those using female-only methods and those using
couple methods? The methods classified as ‘couple methods are less efficacious
than the female-only methods, could this have any bearings on the findings?
6. It would be useful to know to what extent abortions were accessed due to
contraceptive failure, especially for methods like condoms.
7. More detail about frequency of the various types of contraceptives used would
be useful.
8. Results (3rd page of results, under multivariate logistic regression, 2nd para):
One would expect the odds of having an induced abortion to increase with age
as the timespan available for having abortions increases with age. This applies
also to the greater odds of having repeat abortions with age. Could the authors
comment on this?
9. It might be interesting to also undertake analyses with current contraceptive
users. This is not reported in the Tables. Was this done?
10. Were all participants ever-users of contraception? This seems the case from
the Methods Section of the abstract, yet in the Results section of the paper (1st
para) it is reported that 93.5% were ever users? Please clarify.
11. If participants were ever users, but not current users, why did they stop using
contraception? Could, for instance, side effects experienced with the method
have led to discontinuation and ultimately to the need for an abortion?
12. Please explain the term maternal age used on page 9, subsection Bivariate
analysis, line 9; and under Multivariate logistic regression section, line 4. Is this
the age at interview as in the Tables?
13. Results Section, Multivariate logistic regression, line 22: will the authors
explain how they reached the conclusion: “(and were more likely to have reached
their desired number of children)”? This statement is linked to the sentence
indicating that having previously given birth to a daughter resulted in lower odds
of having an induced abortion and having repeat abortions compared to having
previously given birth to a son.
14. Discussion: What findings support the conclusion that participants faced
limited contraceptive access/availability (lines 7-8)?
15. Discussion: What evidence is there that staff at the study sites were poorly
motivated (p12, 2nd page of Discussion).
- Discretionary Revisions
1. Abstract, Conclusion Section: it is stated “ VFP dimensions …. were not
associated with induced abortions” – this may be better phrased as: “women
receiving VFP services …. were not less likely to have induced abortions.
2. Results, Multivariate logistic regression , 3rd para, “working as a farmer was
significantly associated with 43% lower odds of having an induced abortion …”.
Could the authors explain why this occupation (farming) was singled out for
analysis?
- Minor Essential Revisions
1. There are a number of typographical errors as follows:
- P1 (cover page): spacing after superscript 1Department (line 4); Spelling of
Department (line 5)
- Abstract methods section, line 3: should be histories, not history
- Background, para 3, line 7: abortion should be plural – abortions
- Methods, line 10: change to: …and written informed consent was obtained…
2. Acknowledgements: please indicate for what Peter Miller, Dr Ian Askew and Dr
Nguyen Trong Hau are acknowledged.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests