Reviewer’s report
Title:  Contraception and Post Abortion Services: Qualitative Analysis  of Users´ Perspectives  and
Experiences following Zika Epidemic in Honduras.
Version: 0 Date: 06 Feb 2020
Reviewer: Joseph Abi Jaoude
Reviewer's report:
The authors present a qualitative study (interview-based) on the landscape of contraceptive use and
post-abortion care in the context of the Zika Virus outbreak in Honduras. The study shows particularly
low use and access to contraceptive use among women in Honduras. Also, women face extensive
difficulties in trying to access such medical care, a common feature, and problem, for women all over
the world. The authors present relevant data for the readers of BMC Women's health, and to a broader
readership of public health experts. The use of qualitative data is always an asset for public health
research, allowing more room for interpretation and understanding of populations (when compared to
quantitative data). Furthermore, the authors mention strong messages that are crucial in improving
women's health, not only in Honduras, but in many countries with similar background. This work
would be relevant to the public health community as a whole. Few comments on the various sections:
Methods Study design: divide population and intervention for clarity. Methods Ethical aspects: move to
section  before  data  analysis.  Results:  Please  present  median  age  instead  of  mean  Results:  add
percentages, does not have to be added everywhere but at least for findings that are important (less
important findings can have only % in table 2) Results PAC: could you add 2-3 interesting responses
from participants regarding that? Discussion: add a small paragraph at the beginning rephrasing the key
background and objectives of the current study. Discussion: "due to distance to this hospital, but also
the  quality of services  in  the  hospital."  Please  elaborate  on  those  2  points,  maybe  adding  some
references here would be interesting. Discussion: more elaboration on the "macho" culture would be
interesting. Disparities between women and men are present all over the world, it would be nice to
elaborate on that and its effect on women's mental health. Discussion: "Authorities still need to address
the imperative problem of ill-treatment with interventions at various levels; improvement of policy,
health service structure, and continuous training, among others." This message is very important to
convey clearly, however this phrase is quite hard to read. Please rephrase and elaborate slightly to
improve the readability. Discussion: please rephrase this sentence "In another study of Honduran
women, it was found that changes in contraceptive method was common which was indicative of
potential problems with the methods and changing pregnancy desires" Discussion: "In the past years,
due to the support by international organizations, Honduras has been implementing family planning
programs to improve contraceptive supply chains and information flows". This type of interventions are
crucial at a global level. Is there any information on whether such interventions were beneficial and
caused a substantial improvement? Please add that if possible. Discussion: It would be interesting to
elaborate more on the landscape of Zika virus education and awareness over the world. While the
authors mention studies from Brazil and Honduras extensively (and rightfully so), elaboration on
studies  from  other  countries  (South  America  or  others)  is  also  important  (if  possible).  As  such,
elaboration on Zika and woman's health at a global level would e an interesting addition to the
discussion. Conclusions (in main text and also abstract): Please change "highlighted" to "highlight"
Conclusions: Please move the following sentence to the last sentence "Public policies to prevent Zika
epidemics should focus more on providing proper sanitation; removing barriers to access and use of
effective contraception as human rights priority". Also please change the ";" to "and" and I would
suggest deleting "as human rights priority" so that the last sentence of the text would read as follows:
"Public policies to prevent Zika epidemics should focus more on providing proper sanitation and
removing barriers to access and use of effective contraception." Table 2: Maybe put age median and
range (or IQR) instead of mean. Table 2: Education level shows a strikingly low university education
level (11.8%). The following would be interesting to mention in the discussion. With lower education
levels, more need for awareness campaigns arises. This is a strong message in itself. One suggestion
would be to change the title to something lighter to read and understand; maybe something like this:
"Barriers to contraceptive services following the Zika epidemic in Honduras; a qualitative analysis"
Lastly, this is a qualitative study, and as such, ease of readability and understanding is particularly
important. In that context, some parts of the text are difficult to read through, with some sentences
being too lengthy and hard to keep up with. The study presents really interesting data, with very
important, and strong, messages. I suggest reviewing the entire text and editing it for easier readability,
a task that would improve the quality of the manuscript tremendously.
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.
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.
Not relevant to this manuscript
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
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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?
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