Reviewer ’s report  
 
Title: Timing of  abortion among adolescent and young women presenting for post -abortion care  
in Kenya: A cross -sectional analysis of nationally -representative data  
 
Version: 0 Date: 11 Apr 2017  
 
Reviewer: Elisabeth Faxelid  
 
Reviewer's report:  
 
The topic is ve ry important and the paper well written. I have, however, some concerns that I 
would like the authors to consider.  
 
 
 
1. The concepts "timing of abortion" and "timing of abortion care -seeking" seems to be used 
interchangeably in the manuscript. However, these  concepts are different and it would be 
better if the authors decide which concept to use.  
 
 
2. The conclusion in the abstract stating that "Late -term abortions (induced) at or after 12 
weeks were substantial....." is different from the conclusion in the end  of the manuscript, 
which I prefer. The data does not really support the conclusion related to induced 
abortion.  
 
 
3. In the method section one of the primary explanatory variables is "the nature of index 
abortion (spontaneous, induced) but I don´t see this  variable presented in any of the tables 
e.g. when the logistic model is presented in the result section. It is important to draw 
correct conclusions and stick to the actual data e.g. second trimester abortion, severity of 
complications etc. As far as I se e we really don´t know the proportion of unsafely 
induced abortion in this material and the authors need to be careful when drawing 
conclusions. What is presented is that 61% of the women stated that the pregnancy was 
not wanted or mistimed. This might ind icate that 39% was wanted and the abortion not 
induced but spontaneous. This need to be discussed in the paper. Often women who seek 
PAC are treated as they have induced the pregnancy, which often is not the case. Then 
these women are stigmatized although they have actually done nothing to end the 
pregnancy.  
 
 
4. Fig 1 is also a bit unclear to me. Here it indicates that all women had an induced abortion, 
which most probably was not the case.  
 
 
5. It is stated in the text in the result section that "A greater proportion of young women 
presenting for PAC for pregnancies terminated after more than 12 weeks of gestation 
(40%) than those presenting for pregnancies less than 12 weeks gestational age (33%) 
were aged 12 -19 years". This statement is unclear. How do you  know that pregnancies 
were terminated? Further, these figures are not presented in table 1 where results are 
presented differently. I would prefer to see the proportion of the two age groups who had 
early or late timing of abortion (or abortion care -seeki ng) presented in the table.  
 
 
6. In the head of table 3 it is stated -<12 weeks gestational age. It should probably be ->12 
weeks gestational age.  
 
 
7. In table 3 is is shown that those who "wanted later" or "never wanted" a pregnancy 
actually had a lower risk of 2nd trimester abortion - how come? How does this relate to 
your view that second trimester abortion is more related to induced abortion?  
 
 
8. The first sentence in the discussion is: "Post -abortion care for complications is a key 
indications that the initial procedure may have been unsafe". This statement clearly needs 
refs since many women seek PAC for complications related to spontaneous aborti on as 
well. See my previous comment related to stigma.  
 
 
9. Ref 24 is put after the statement that "Adolescents have also been shown to be more 
likely to seek clandestine abortion care than older women". I have read this ref and it can 
hardly be correct ref . Please check!  
 
 
10. You state in the discussion that "young women in rural areas may be particularly 
vulnerable to problems associated with unsafe abortion". This might be a correct 
assumption but hardly shown in your data.  
 
 
11. The suggestions in the con clusions are fine but I think the link to unsafe abortion is not 
clearly backed up by your data.  
 
 
 
 
 
 
 
 
 
 
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 necessary 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.  
 
No 
 
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 req uire further  
assessment in your comments to the editors.  
 
I am able to assess the sta tistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following qu estions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
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3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing i nterests in relation to this paper?  
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