Title: Association between history of abortion and current use of contraceptives among
Mongolian Women
Version: 1 Date: 10 Feb 2022
Reviewer's report:
The objective of this study was to use national survey data to describe the association between
history of abortion and current use of contraception in Mongolian women. The public health
goal is utilize the results of this study inform strategies that increase contraceptive uptake since
contraception use has declined in Mongolian women, while approximately 24% use abortion as
a pregnancy prevention method.
1. Introduction, 3rd paragraph, 1st sentence: revise to ‘It is estimated that 24% of women…’
2. Introduction 3rd paragraph: Most of this needs extensive revision for sentence structure and
grammar. Also, it contains contradicting statements regarding to access to contraception (one
sentence it says it is restricted and then states that there are no limitations. Please clarify and
revise. Perhaps information regarding contraception use is limited and not access.
3. Introduction in general is rambling and redundant. Authors should streamline the issues.
That contraceptive uptake is declining and that 24% of Mongolian women use abortion as a
method of birth prevention. While there does not appear to be access limitations to abortion or
contraception, the dissemination of information on available contraceptive methods and their
use seems to be lacking. Also, clearly establish the public health goal – increase uptake of
contraception and decrease abortion use (presumably to decrease health risks that are attributable
to elective abortions).
4. Methods, 1st paragraph states women aged 15 and above were included but then later states
the age range was 15-49. Please clarify.
5. Methods: History of abortion definition - Should be limited to elective terminations if possible.
If not, is it at least possible to exclude miscarriage and still births as those usually represent
wanted pregnancies?
6. Methods: The major issue with this manuscript is how contraception use categories were
defined and their use in statistical models. The authors need to create mutually exclusive
categories so that the referent group is equal across categories (i.e. no current contraceptive
use vs IUD vs pills vs implants, etc). For instance, when you categorize pills yes/no then you
are comparing pill users to everyone else which included non-contraceptive users, IUD user,
implants, etc. thus your reference group not only changes for each method, but may contain
disparate populations that likely do not share the same characteristics. The resulting associations
for individual methods can be false or diluted.
7. Some of the covariates are missing for more than 25% and should not be used in multivariable
models (age of alcohol use, age of husband).
8. Some covariates have collinearity issues (i.e alcohol use=no and age of alcohol use=never),
many of the age variables, ever pregnant and number of children. Models should be evaluated
with ad without some of these variables separately and combined. This is why some are highly
significant in univariate analyses and not in multivariable analyses.
9. The statistical package used does not need to be a separate paragraph.
10. Results: please specify which methods were LARC, which were permanent non-reversible
method, and the eight contraceptive methods consider for analysis in this study. This probably
should be specified in the methods.
11. Percentages in Table 1 and 2 are an incorrect representation. The percentages should be
column or row percentage, not percent of total for them to have a meaningful interpretation. For
instance, the prevalence of abortion history is 31% among Khalkh women, 23% among Kazakh,
and 28% among other.
12. The discussion will need to be revised pending new analyses.