Title: Barriers to Pregnancy Prevention for Adolescents in Rural Haiti: Perceptions of
Healthcare Providers
Version: 1 Date: 13 Dec 2023
Reviewer's report:
The authors report on the attitudes and beliefs about adolescent and young adults and
contraception from the perspective of healthcare providers in two rural sites in Haiti.
Participants were interviewed using quantitative (N=58) and qualitative (N=17) study designs.
The primary limitation of the quantitative survey was the low number of participants.  Given the
small sample size, together with the convenience sampling, it is unclear whether the findings
can be generalized to any larger group.  This reduced enthusiasm for the report.
Another limitation is that the authors do not report on the definition of adolescent or young
adults used in their study questions.  It seems likely that healthcare providers could have very
different attitudes about contraception use among a girl 13 years of age versus a married woman
of 22 years of age.  The analysis was somewhat superficial in not trying to capture differences
in views of AYA.  Note that the Results section could be reduced substantially without losing
much from the report by referring to the figures rather than reporting on each finding.
Specific comments:
1. Abstract, Background, last sentence: The meaning of this sentence isn’t clear to me.  Does this
refer to ways in which HCPs act as barriers or facilitators to contraceptive care – or something
else?
2. Abstract, Methods: When was the study conducted?  Also, the abstract should report the N
for the qualitative study.
3. Abstract, Methods: What does “perceived behavioral control” refer to?  This term should be
explained here and later in the document.
4. Introduction, first paragraph, first sentence: When are these estimates from?
5. Introduction, second paragraph, second sentence: The authors need to provide a citation for
the claim that global health guidelines recommend contraceptive care for all.  Contraceptive
care isn’t needed for those at no risk of unintended pregnancy and, from a patient-centered care
perspective, contraceptive care wouldn’t be appropriate for those who oppose, or have other
reasons for not wanting, the use of contraception.
6. Methods, second paragraph: The authors report the inclusion criteria but do not report how
many clinical staff were eligible for participation and declined to participate.  This information
should be reported to better understand the potential for selection bias.
7. Methods, fourth paragraph: The authors included a subset of the quantitative participants into
the qualitative part of the project.  How did they decide to recruit an N of 37 for the qualitative
study and how did they decide which to recruit to this?  Only 17 participated in the qualitative
study.  Were there any differences between those who agreed or declined?
8. Declarations, Ethics Approval and Consent to Participate: This section talks about assent and
consent process for adolescents and young adults.  However, this is not relevant to this report.
This section should instead report on the consent process for the healthcare provider participants
in the present report.
9. Figures 2 and 3: Please report the number of participants that were included in these measures.
Also, please add the Ns to the rows so that the reader can see the numerator and denominator
for each outcome.  Reporting this in the manuscript is a requirement of STROBE.
10. Table 1: Please specify how these factors relate to those who participated in the qualitative
study.