Title: Machine learning to predict unintended pregnancy among reproductive-age women in
Ethiopia: evidence from EDHS 2016
Version: 1 Date: 15 Oct 2023
Reviewer's report:
Abstract Section
Background
1.   Authors should decide between using either "Unintended" or "Undesired" in their writing,
and it's crucial to maintain consistency in the choice of words.
2. Authors may consider condensing the information where possible to enhance clarity and
keep the reader's attention. For instance, the sentence "It is one of the most important issues
the public health system is currently facing, and it comes at a significant cost to society both
economically and socially" could be more specific. Provide data or statistics if available to
quantify the economic and social costs, making the statement more impactful.
3. I think authors should also consider adding a sentence to transition smoothly from the
discussion of the issue to the purpose of the study. For example, authors could mention briefly
why it is essential to explore predictive methods in addressing unintended pregnancies, linking
it back to the challenges highlighted in the previous sentences.
Methods
4. While it mentions the use of six machine-learning algorithms, it could be beneficial it would
be advantageous if the authors could specify which algorithms were used. This detail would
provide readers with a clearer understanding of the study's methodology.
5. Authors should consider providing a brief rationale for the choice of the six specific machine-
learning algorithms and also state briefly why they were deemed suitable for this specific study.
6. Authors should also provide a brief sentence on why the 2016 Ethiopian Demographic and
Health Survey data was chosen.
Results
7. Authors mainly intended to use ML to predict unintended pregnancy, but in the result section
of the abstract there are no results from the predictive modeling conducted. This should be well
accommodated.
8.  Authors should briefly highlight the implications of these findings in the context of public
health or social policy in Ethiopia or globally. How might this knowledge be applied to prevent
unintended pregnancies and improve reproductive health outcomes?
Conclusion:
9. If possible, authors may consider providing specific examples of policy recommendations
based on the identified predictors. Concrete suggestions can make the conclusion more
actionable for policymakers and public health professionals.
10. Authors should also briefly mention potential avenues for future research in this area. Are
there specific aspects or variables that were not covered in this study but could be explored in
subsequent research?
11. It is important for the authors to provide a brief statement on the broader societal significance
of improving policy decisions related to unintended pregnancies. How might this contribute
to overall public health, social welfare, or economic development? Understanding the broader
context can help readers grasp the importance of the research beyond the immediate topic.
MAIN BODY
Introduction:
12. Line 69 -72: “The child of an unintended pregnancy is more likely to be maltreated, to be
born weighing less than 2,500 grams, to die within the first year of life, and to lack the resources
necessary for healthy growth.” This statement needs citation.
13. LINE 49 =52 needs a citation
14. In line 53, authors should decide between using either "Unintended" or "Undesired" in their
writing, and it's crucial to maintain consistency in the choice of words.
15. Line 96-98: While building a justification on utilizing ML techniques, it’s inappropriate
to generalize that the statistical techniques provide erroneous results. Authors may consider
rewriting this sentence.
Methods:
16. Authors should also provide specific reasons for using the 2016 Ethiopian Demographic and
Health Survey data.
17. Data pre-processing techniques should form one of the comprehensive parts of this write-
up. It is an essential step in ML predictive analytics.
18. In the “feature importance” section, authors may want to include the basic mathematical
formula used for information gain. The python packages/libraries for all the algorithms used
should be at least mentioned once.
19. In the “Data splitting” section, the ratio of split should be specified and justified.
20. Since the authors have included the Imbalance learning objective, it is important to specify
the level (or ratio) of data imbalance that was available in the dataset prior to predictive model
building
21. In addition, there are a number of imbalancing techniques that could be used. Authors should
justify as to why they embarked on using SMOTE in this write-up.
RESULTS
22. Table 2 does not look so good. Authors may consider making it a three-way table
23. Where is Table 1 anyway?
24. Figure 5 depicts the Feature importance for Extra-Tree classifier. What about other
techniques used?
DISCUSSION
25.  Line 361: The statements “In findings, our study shows that machine learning techniques can
be used to identify predictive characteristics related to unwanted pregnancy. Machine learning
methods appear to be useful for determining which indicators are most important for predicting
an unplanned pregnancy” looks like the authors were trying to measure the usefulness of these
methods apart form testing the predictive performance of various ML algorithms. Authors
should reflect on their study’s objective
26. If possible, authors may consider providing specific examples of policy recommendations
based on the identified predictors. Concrete suggestions can make the conclusion more
actionable for policymakers and public health professionals.
27. Authors should also briefly mention potential avenues for future research in this area. Are
there specific aspects or variables that were not covered in this study but could be explored in
subsequent research?
28. It is important for the authors to provide a brief statement on the broader societal significance
of improving policy decisions related to unintended pregnancies. How might this contribute
to overall public health, social welfare, or economic development? Understanding the broader
context can help readers grasp the importance of the research beyond the immediate topic.