Reviewer ’s report  
 
Title: The associations betwee n Intimate Partner Violence a nd maternal health care service 
utilization: A systematic review and meta -analysis  
 
Version: 0 Date: 14 Aug 2018  
 
Reviewer: Kelly Young -Wolff  
 
Reviewer's report:  
 
This is a well written manuscript that examines  the associations between Intimate Partner 
Violence and maternal healthcare service utilization. This is an important topic and a unique 
contribution to the field. My comments are below.  
 
1. Please consider defining antenatal care and skilled delivery car e prior to the Methods. It 
would be useful to indicate what specifically is meant by these terms in the current study 
earlier.  
 
2. The interpretation of ORs that are less than 1 is often difficult for readers. I might 
recommend that the authors instead re port the ORs among those without intimate partner 
violence relative to those with intimate partner violence, so that the ORs are greater than 1 
and more easily interpretable. Alternatively, consider adding a few lines to explain 
appropriate interpretation of the ORs.  
 
3. Quality and Risk of Bias Assessment: Is there a citation for including articles with NOS 
scores above 3? Please provide or explain the rationale for this cutpoint.  
 
4. The Discussion section would be improved by further interpretation of the study findings. 
For example, why would physical intimate partner violence have the strongest association 
with inadequate utilization of ANC? The authors provide one possibility, that those who 
experience physical IPV don't want to seek medical care for  fear of being exposing the IPV. 
However, many of the studies included lifetime IPV, not necessarily IPV that occurred 
during the pregnancy. Additional discussion of potential mechanisms is needed.  
 
5. Please add to the limitations that some of the studie s included lifetime exposure to IPV and 
you were unable to address the timing of IPV, whether IPV was recurrent, or distinguish IPV 
during versus prior to pregnancy.  
 
6. In the Discussion section, the authors summarize other possible factors related to re ceiving 
adequate ANC and SDC. It is unclear why this section discusses factors related to receiving 
adequate ANC and SDC when the associations with IPV were reported for inadequate ANC 
and SDC. In addition, it would be more helpful to the reader if this se ction included the 
direction of effect. For example, replacing "age of the women" with "younger age", etc.  
 
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.  
 
Yes 
 
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 manus cript 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.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscri pt: 
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either no w or in the future?  
 
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 interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I  declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my  report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access C reative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal