Reviewer ’s report  
 
Title: Abortion Laws reform may reduce Maternal Mortality: An Ecologic al Study in 162 
Countries  
 
Version: 1 Date: 21 May 2018  
 
Reviewer: Ulf Högberg  
 
Reviewer's report:  
 
This is an important and innovative study.  
I propose a change of title, from purely descriptive to include the message "Abortion law reform 
may reduce maternal mortality: An Ecological Study in 162 countries."  
Methods of analysis,  fixed effects regression model, is robust for the dataset provided, and taking 
into account the general decline of MMR. However, the deviance of an increase in the 
coefficient Score 4, Score 6 (Table 4) could be commented in the Results, whether it is due  to 
few observation or not.  
One basic limitation to the study design is addressed p 11 r 36 -56, i.e. the possibility that 
abortion law does not reflect access to safe abortion, with the example of Bangladesh (Score 2) 
having wide access to "menstrual regul ation". However, this limitation is bigger than that and 
has to be addressed more thoroughly, namely, the worldwide trend change from surgical 
abortions towards medical abortions by misoprostol since the 1990s, whether approved by the 
authorities or off -label. The process has been described from several Latin -American countries 
as lifesaving, decline in abortion related mortality, while still restrictive abortion laws has been 
unchanged (Faundes 2011, Eur J Contraception & Reproductive Health Care). I sugge st further 
sensitivity analysis. What would the results be if you exclude from analysis Bangladesh and 
Latin -American countries?  
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 ne cessary 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.  
 
Yes 
 
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 am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
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below.  If your reply is yes to any, please give details below.  
 
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