Reviewer ’s report  
 
Title: Factors associated with seeking post -abortion care among women in Guangzhou, China  
 
Version: 0 Date: 07 Jan 2020  
 
Reviewer: Safdar Ali  
 
Reviewer's report:  
 
Title:  
 
Factors associated with seeking post -abortion care among women in Guangzhou, China.  
 
The manuscript entitled "Factors associated with seeking post -abortion care among women in 
Guangzhou, China" deals with the Post -abortion care (PAC) service and use of PAC in 
Guangzhou China. Further, the authors have demonstrated statistically the influen ce of factors 
for adopting PAC, considering a total of four Hospitals where the Govt has set a public facility of 
family planning services.  
I have some remarks and suggestions to improve the manuscript accordingly:  
 
Comments:  
 
English and grammar should b e improved throughout the manuscript and should be checked by 
any native writer. The sentence structure was seemed to be written poorly throughout the MS and 
do not make proper sense of reading. In my opinion, the authors have tried their best but still, t he 
motivation of this work is weak. In the current form and content, this study does not display the 
impact needed for publication. However, the MS should be only accepted for publication on 
condition that authors should follow the detailed major comments,  as given below:  
 
1. Line 26 -27: "into existing abortion services in hospital settings where the vast majority 
of induced abortion is performed". This sentence is confusing to the reader, please make it 
simple with a clear sense.  
2. Line 27 -29: "This stud y aims to assess post -abortion care (PAC) utilization and identify 
factors affecting PAC uptake among clients on the day of abortion in Guangzhou, China". Why 
the authors have used the present tense in this sentence? The language of MS should be in the 
past tense.  
3. Line 30: "Methods: This paragraph is not clear, try to make it simple with clear 
meaning.  
4. Line 37: You can write this section as: "The PAC counseling rate of subjects was noted 
as 42.1% before left the health care facilities. Meanwhile, mul tivariate logistic regression 
analysis showed that unmarried women, women with local household registration, women 
perceptive that fertility could return sooner after abortion and women themselves as the main 
decider on PAC use were significantly associate d with PAC utilization".  
5. Line 42: Conclusions: This paragraph is not clear, try to make it simple.  
6. Line 68: The word "constituted" is not suitable, change this with another word.  
7. Line 70: "ineffective or non -use of contraception or contraception f ailure". Rearrange 
the sentence with proper meaning.  
8. Line 74 -76: "The causes are complicated. One of the major reasons is limited access to 
high quality post -abortion care (PAC), which is a key component for contraception initiation". 
Rearrange the sen tence with proper meaning.  
9. Line 77 -78: You can write like this "WHO has advised the counseling and provision of 
certain contraceptive services to all those women who wish to prevent unintended pregnancies 
and subsequent IA.  
10. Line 78 -80: You can writ e like this "The term PAC, was first time used in 1991, which 
is referred as an approach to break the continued pregnancies, in turn, may improve women's 
sexual as well as reproductive health"  
11. Line 80: Change "Integration" to "The Integration"  
12. Line 81: Change "the essential" to "an essential"  
13. Line 84 -89: From "However to disapproval". The paragraph is not clear, you should 
modify it with clear sentences.  
14. Line 89 -92: You can write like this "Despite the efforts that have been done in 
improvin g the accessibility and quality of PAC, a little bit of research has only assessed the 
factors that may affect women's acceptance of PAC. Moreover, the quality of PAC at public 
hospitals in China is often found low, with limited provision of trained staff to abortion clients".  
15. Line 92 -94: "This is of particular importance when considering the unmet reproductive 
health needs of vulnerable groups such as migrants, young people and adolescents". Please 
define this with clear meaning, it is confusing to re ad and understand.  
16. Line 97 -108: "FP services to on the day of abortion". This paragraph is a little bit 
confusing in reading, modify it.  
17. Line 115 -118: You can write like this "A cross -sectional survey study was conducted at 
the Tianhe district of  Guangzhou during the period of June to September 2018. All those women 
who have experienced at least once IA in the selected public hospitals were included in the 
present study. However, we excluded those women who were unable to speak and listen to or 
having any psychiatric disorder".  
18. Line 127 -133: Sampling procedure: You can write like this "Four public hospitals at 
Tianhe district providing PAC services, were pilotly included in the present study. The average 
number of PAC users was estimated accord ing to the recent quarterly report of clients flow in 
each hospital. A systematic random sampling method was applied, and the number of 
respondents in each hospital was determined using the population proportion to size. The sample 
size in each selected ho spital was seen as 156, 119 and 148 respectively".  
You have selected a total four hospitals, but the number of participants is only exposed to three 
hospitals. What about the fourth one hospital?  
19. Line 135: "The data was" to "The data were" and place t he article "an" before 
anonymous.  
20. Line 136 -37: Write like this "The questionnaire was designed with the help of the 
literature and it was reviewed by the experts in reproductive medicine and clinical epidemiology.  
21. Line 144 -150: Write like this: Aft er obtaining the informed consent, all the participants 
were interviewed face -to-face, moreover, they were assured regarding the confidentiality of their 
identity and responses. The data collection phase was completed with the help of seven post -
graduate f emale nurses. They were trained for two days by the principal investigator covering the 
interview techniques, quality control, completeness and ethics of data collection process.  
22. Line 152: "Data were" to "The primary data was"  
23. Line 154: "differences" to "the difference"  
24. Line 155 -157: Rearrange the sentences to show proper meanings.  
25. Line 159 -160: Write like this "The study protocol was approved by the Research Ethics 
Board of Southern Medical University, China. All the pa rticipants were asked to sign written 
permission prior to the intertwining".  
26. Line 161: Results Section:  Please have a look at the section Sampling procedure (line: 
127), here you have mentioned the number of participants as 156, 119 and 148, the total  sum is 
423.  Then see the Results, Line 162:  Of the 431 women estimated in sample size, a total of 413 
abortion clients were interviewed. Correct the statement.  
27. Line 162 -163: Rearrange the sentence.  
28. Line 169 -170: Rearrange the sentence.  
29. Line 175-187: Write like this: "Multivariate logistic regression analysis revealed the 
factors that may influence the PAC use as shown in Table 4. Unmarried women were found two 
times more likely to receive PAC than married women (OR:2.146, 95% CI: 1.253 ～2.414.  The 
odds ratio of women having local household registration was higher as compared to the migrants 
(OR:2.478, 179 95% CI: 1.989 ～3.743). In addition, the main decision -maker to avail the PAC 
was seen as a significant factor for seeking PAC. Moreover, the o dds ratio of receiving PAC 
among clients who were self -decision makers was three times higher as compared to those 
women whom deciders were husband/partner (OR:2.901, 95% CI: 2.005 ～3.416). In this study, 
significant use of PAC was noticed among those clien ts who were conscious that they could be 
pregnant sooner. Further, the women who know that fertility might be faced within 10 -14 days 
were observed to utilize PAC three times more, when compared with those who do not know 
about it (OR:3.116, 95% CI: 1.971 ～3.878)".  
30. Line 189 -191: Write like this: "This study was aimed to determine, the proportion of 
women who received the PAC among abortion clients, and the possible factors that may be 
associated with PAC utilization in Guangzhou, China".  
31. Line 191: "m agnitude" to "degree"  
32. Line 192: "was 42.1%" to "was found 42.1%"  
33. Line 192 -193: Write like this "which seems to be lower than a previous European 
framework project done in three cities of China".  
34. Line 193 -194: The authors have provided the prev alence examples of other countries. It 
would be better to show here the comparative results from other cities in China.  
35. Line 198: Write like this: "the health care system".  
36. Line 200: Write like this: "to pilot the provision"  
37. Line 201: Write lik e this: "into the Chinese health system".  
38. Line 202: Write like this: "seeking an abortion, therefore, were".  
39. Line 204 -209: Rearrange the sentences with proper clear meanings.  
40. Line 210 -211: Start the paragraph like this. "In this study, unmarrie d women were seen 
two times more likely to utilize PAC as compared to married women.  
41. Line 211 -212: You should provide some comparative findings from other cities in 
China beside other countries.  
42. Line 213 -221: You can write like this "Considering th e fact, it could be concluded that 
unmarried women had a good awareness of reproduction and contraception. Moreover, in 
Guangzhou, the government at all levels has taken initiatives to educate young and unmarried 
people regarding reproductive health knowle dge including explicit attention to discussing 
ambivalent attitudes towards their sexuality and developing a youth -friendly stance in 
counseling. The efforts have also been made to overcome certain barriers with large migrant 
populations. On the other hand , schools have also played an important part in this field. 
Additionally, the seek for PAC services suggests that contraceptive methods have not been 
appropriately used to avoid unintended pregnancies.  
43. Line 221 -222: "Training to develop critical think ing on cultural and ethical dimensions 
attached to sexuality among unmarried people may be effective here". Rearrange the sentence to 
make a clear sense.  
44. Line 223: "The odds of" to "The odds ratio of using PAC was"  
45. Line 223: "among women" to "amon g those women"  
46. Line 224: "than those without" to "as compared with migrants"  
47. Line 128 -129: "Further study is needed" to "Henceforth additional studies are 
required".  
48. Line 231 -233: Write like this "This finding was comparable with previous studi es 
conducted in Ethiopia, suggesting that FP utilization is associated with a decrease in repeated 
IA". 
49. Line 233 -242: "It implied that post -abortion to practice of modern contraceptives". This 
whole paragraph seems to be very important. Hence the autho rs should try to write it again with 
clear explanation.  
50. Line 245 -247: "The same studies from Egypt and Nigeria concluded that women who 
failed to receive PAC are because of disapprovals from their husbands". I advise to show here 
some comparable findin gs from Mainland of China.  
51. Line 247 -248: "This may be explained by their being not involved in PAC. Men are 
usually not allowed to access the department of gynecology in China". Rearrange these two 
sentences.  
52. Line 251 -252: "A number of studies suggest the importance of male involvement in 
women's use of contraceptives". Please avoid the shortcut meaning sentences, explain with 
proper sense.  
53. Line 265 -272: Please write the paragraph again, and convey a clear message to reader.  
54. Line 273: Conclusion: The language and sentence structure seem to be poorly written. 
It must be restructured.  
 
 
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 expl ain 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  
assess ment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
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 financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now 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 yo ur reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
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