Title: Exposure to family planning messages on social media and its association with maternal
healthcare services in Mauritania
Version: 0 Date: 05 Dec 2023
Reviewer:  Akira Shibanuma
Reviewer's report:
The authors investigated the association between receiving family planning messages on social
media and receiving maternal health services in Mauritania, using a nationally representative
dataset.
1. Scope of this study: At the end of the Background section, the authors stated that they
“investigate the association between exposure to family planning messages on social media and
maternal healthcare service utilization in Mauritania.” While it is appropriate that the authors
employed a multiple regression analysis, it would be out of scope that the authors discussed the
roles of other significant factors associated with receiving maternal health services in Mauritania
in the Discussion section. The authors might want to reconsider the contents in the Discussion
section and focus on the roles of family planning messages and the roles of social media as a
means of health promotion to improve the uptake of maternal health services.
2. The contents of family planning messages: The authors seem not explain the definition of
“exposure to family planning messages on social media” in the Methods section. Particularly,
they might want to explain if women were exposed to messages before the latest pregnancy or
anytime before the data collection date. They could cite the exact word in the DHS questionnaire
regarding exposure to family planning messages on social media.
3. Typical family planning messages on social media: The authors introduced that “Studies
have explored the potential impact of exposure to family planning messages on social media
on maternal healthcare service utilization;[20–22]” However, it would be questionable if such
family planning messages contained direct information about the importance of antenatal care
and facility delivery, which this study focused on. Typical family planning messages may
focus more on the importance of family planning, such as birth spacing, shared decision-
making on the intention to have a child, and contraceptive methods. The authors might want to
introduce what kinds of family planning messages are available on social media that women in
Mauritania typically read, even though the DHS questionnaire might not define it in detail. If the
Government of Mauritania, the country offices of international organizations and NGOs working
in Mauritania distributed family planning messages on social media, the authors could introduce
them in the Background section. They could introduce typical family planning messages in
Arabic, French, or other languages that women in Mauritania typically understand.
4. Comparison: It is understood that social media is growingly important as a means of delivering
family planning messages. Nevertheless, it is questionable to treat the exposure variable as
“exposure to family planning messages on social media” or not. It is because women categorized
as “No” in this variable included those who were exposed to family planning messages from
other sources and women who were not exposed to family planning messages at all. The authors
might want to consider including variables that captured exposure to family planning messages
on other sources than social media. By doing so, they would be able to obtain the association
of exposure to family planning messages on social media, compared to non-exposure to family
planning messages.