Title: The trends of female sterilization in India : An Age period cohort analysis approach
Version: 1 Date: 02 May 2022
Reviewer's report:
Overall comments to author
• The manuscript is interesting and important; however, it is not very clear which is the main
message. What is the research question that you intend to answer?
• You need to focus on this main message/story you want to leave in the reader’s mind.
• Please check your manuscript to be sure it is an English version for a global audience.
• The manuscript needs a justification for using Age, Period, Cohort methodology. Why is this
method useful to study this phenomenon?
• Also make clear the link between birth date, period, and age.
• Please explain with more detail the models you use in your analysis; they are not clear.
• You could use literature more international, from the WHO. This to make your paper more
accessible for a global audience.
• The results could be a shorter section. At the end of every section there is a paragraph where
you discuss your results, this should be in Discussion section.
• Please be more careful with some rude language like “incompetency of government…”
Reflection points
• When you talk about forced sterilization, does the women know that they were sterilized? You
are using a survey that uses self-report then forced sterilization should be known by women.
• It could be interesting if you focus just in one of the variables as education and talk about how
it appears that women with less education are still being coerced to get sterilization.
Abstract
1) Lines 1-3: It is missing a context that gives us a reason to study sterilization trends in India
2) Lines 1-3: Explain the maximum entropy approach and the APC analysis and why these
methods are useful to understand the phenomenon you are studying
Introduction
3)  Line 1: Who have been concerned about the rapid population growth? Which country are
you talking about and when does the independence took place? Please give more detail in this
first sentence
4) Line 1-3: Maybe you can contextualize this sentence in the global environment. Mention
that this concern was growing in the hole world particularly in developed countries about the
population growth in the undeveloped countries
5) Lines 5-6: Please clarify which service delivery points were expanded, contraception
delivery?
6) Lines 6-8: Where does the Government made available contraceptive methods, in the health
facilities or there were extra delivery points just for contraception delivery?
7) Lines 8-10: Please give more information about this mass forced sterilization, it was part
of the programme mentioned before? In which sense it was forced sterilization? You haven’t
mention anything about forced family planning up to now
8) Lines 11-12: How coerced sterilization was different of forced sterilization? Please explain
the differences between both policies
9)  Lines 13-15: How this “trick sterilization” was implemented?
10)  Lines 16-17: What is the family welfare approach? Please explain more about this
11)  Lines 26-27: Please give more context about the decline in male sterilization, and is it correct
that it declines from 74% to 1.2%?
12)  Line 35: What does “FP” means? Please clarify
Data sources
13)  Lines 6-11: Why do you mention DHS and Census Enumeration Block? Does the NFHS
take its sampling frame from these other sources?
14)  Lines 11-16: Please clarify which years are in NFHS-1, NFHS-2…
15)  Lines 11-16: Why are you mentioning sample size of men? Are you using information of
the men sample? If not, please do not mention
Sample
16)  Lines 1-3: I think this paragraph need some redaction check. Maybe first mention the
inclusion criteria (married, sterilized women in reproductive age -15-49) and then mention the
sample size for each wave of the survey
17)  It is not clear the population you’re studying. You said that married, sterilized women
in reproductive age conform your sample; however, you have prevalence of sterilization then
I suppose that you also include not sterilized women. To estimate prevalence, you need to
include women sterilized and not sterilized women in the denominators. Please clarify your
denominators.
Statistical analysis
18)  Lines 15-17: Please give a little more information of the different kinds of approaches to
know their differences
Results
19)  Line 1: Please review redaction. You repeated “period” two times.
20)  Line 4: Women born in the year 1956 were more likely to get sterilized than who?
21)  Lines 5-7: When does the independence took place? Please clarify the date, not all your
readers will know that specific date
22)  Lines 7-8: Please clarify in which figure or table we can see this information or if it is data
not shown
Age effect
23)  Lines 23-25: Please review your redaction. I think there is a mistake “Among the poor and
rich in India, it was found that around 33% of the RURAL women were…”
24)  Lines 26-28: “The decomposition analysis found that the peak of female sterilization starts
at age 30, and remains stagnant till age 40, then decreases with age.” Please clarify which women
are you talking about, poor or non-poor?
25)  Lines 23-32: You are missing some interesting results within the middle wealth quintiles
(Poorer, Middle & Richer)
26)  Lines 53-56: Please check your redaction I think there is a mistake it says: “… while women
at parity two generally adopt sterilization at later ages.” I think you mean “early ages”
Period effects
27)  Lines 5-7: Please clarify, in NFHS-3 sterilization rates increased by eight percentage points,
in Table 1 it says that sterilization in 2005 is 37.7 which is an increase of 3 percentage points.
If the increase, you are talking about is from 1992 then the increase is 10 percentage points
28)  Lines 9-13: I think there is a mistake, in the text you say that in urban areas, the rates were
lower than in rural areas, but the Table 1 say the opposite
29)  Line 20: Again, in the text you say that sterilization rates were higher among poor women
compared with the non-poor, but the Table 1 says the opposite
Cohort effects
30)  Lines 12-15: Please clarify where I can find this information or if it is data not shown
Table S1: Add name to the first column