Reviewer's report
Title:Sexual coercion among married women in Nepal
Version: 2Date:23 July 2010
Reviewer: Chelsea Polis
Reviewer's report:
Major compulsory revisions
1. There are still many grammatical errors. The authors are strongly advised to
ensure that the manuscript undergoes critical reading and editing by someone
with high proficiency in English before resubmission.
2. I am extremely concerned about the integrity of the literature review. In some
instances, the references cited do not appear relevant to the text they are being
used to support. It is impractical for me to review each reference cited, but as
one example, it is unclear why the Cokkinides 1999 study or the Gazmararian
1996 study, which both looked at violence during pregnancy, are cited as
references supporting the statement that sexually coerced women are more likely
to have unwanted or mistimed pregnancies. Please ensure that every cited
reference is relevant to the topic at hand.
3. The definition of sexual coercion is still used inconsistently (sometimes called
lifetime sexual coercion, sometimes called sexual coercion by husband), despite
responses in the cover letter stating that this had been corrected. To avoid
confusion, please ensure that a consistent phrase is used every time, such as
“lifetime sexual coercion by a husband”.
4. 3rd sentence in abstract conclusion and a sentence in conclusion of the paper
seem to suggest that reducing the incidence of sexual coercion of women is for
the purpose of protecting families, not abused women’s health and rights. Other
benefits (such as enhanced family well-being) may also stem from reducing
sexual coercion, which can be stated, but the sentence should be revised so as
not to lose the importance of protecting women’s health and rights.
5. 2nd paragraph of background section needs major revision. The authors state
“representative studies” but don’t clarify what regions the studies are
representative of. It is unclear where they drew the “20%” figure from, is this a
worldwide average? If so, it needs a reference. If not, I would suggest providing a
range that has been documented in the literature from different studies. Please
also consider highlighting statistics on sexual coercion in countries with similar
contexts as Nepal, for comparative purposes (have there only been nationally
representative studies on this subject in US, Australia, India, and Banglasesh, as
implied in the conclusion?). Also, it is still unclear why small, non-representative
studies from Papua New Guinea and India are mentioned in this section.
Perhaps part of the problem is that nationally representative prevalence statistics
exist for sexual coercion, but not specifically sexual coercion by husbands? If so,
please clarify this so readers know why you are including those smaller studies.
6. The text does not note out of how many districts in Nepal four were chosen,
where those chosen districts are geographically, or how they may differ in from
other parts of the country. Providing this information may help readers
understand if this data is nationally representative of married women in Nepal, or
characterizes only particular regions.
7. It is unlikely that confidentiality can be entirely ensured entirely by only
removing personal identifiers from forms, as implied in the text. Where did the
interviews occur and how was privacy protected during the interview? For
example, is it possible that family members overheard the interviews? Several
articles address specific concerns associated with ethical conduct when
conducting research on intimate partner violence, two are listed below, others are
likely available: the authors may wish to familiarize themselves with this literature
and ensure that they have reported adequately on all protections put in place
during this research.
a. Btoush R, Campbell JC. Ethical conduct in intimate partner violence research:
challenges and strategies. Nurs Outlook 2009, 57(4):210-6.
b. Sullivan CM, Cain D. Ethical and safety considerations when obtaining
information from or about battered women for research purposes. J Interpers
Violence 2004;19(5)603-18.
8. The authors state in the discussion that the reason that husband occupation
type is associated with sexual coercion might be a result of wives education, yet
your model controlled for literacy. Please clarify.
Minor essential revisions
Abstract
1. 2nd to last sentence in results section of abstract needs to be clarified,
because it sounds like you were testing an interaction between sexual coercion
and alcohol use.
2. Be consistent – report ORs for all factors in abstract, not just some.
Background
1. 1st paragraph: The first sentence could be read to imply that unmarried
women don’t face sexual coercion, and should probably be deleted. “Frightened
to engage” should be rephrased as “frightened into engaging in” for clarity
(someone may be frightened to engage in sex but still do it consensually). The
third sentence needs a citation. The last sentence may serve as a better opening
sentence for the paper, but the entire paragraph should be revised for flow. Also,
please address the fact that physical and sexual abuse is not “one” form of
violence, as the sentence currently suggests.
2. 2nd paragraph: “Many studies showed that women are more vulnerable to
sexual coercion.” More vulnerable as compared to what? Please provide
references for this statement.
3. 3rd paragraph: Please provide a reference for this sentence “Sexually coerced
women often turn to drugs as a coping mechanism.”
4. 3rd paragraph: Having “been diagnosed with sexually transmitted infections” is
not a “risk behavior” (although it could be a marker for risky behavior) – please
clarify.
5. 4th paragraph: “The objectives of the paper are to examine the prevalence of
sexual coercion (lifetime) and factors influencing sexual coercion by husbands
among married women in Nepal” should be revised for clarity. One suggestion is:
“The objectives of the paper are to examine the prevalence of having ever
experienced sexual coercion perpetrated by a husband among married women in
Nepal, and to determine characteristics associated with this event.”
6. “Right activist” should be revised to say “rights activists”.
7. Reference numbers in the text should appear in numerical order.
Methods
1. In the explanation for the “power relations” variable, does “high power” mean
high power for the woman or the man? From the numbers in Table 1, I think you
mean “woman’s perceived degree of power in relationship”, which may be a
clearer term to use compared with “perception regarding power relations”.
2. Why is literacy and education combined into one variable for men, but not for
women (literacy only)?
Results
1. “Slightly more than a quarter of the women had 'love marriage' (identified by
simultaneous marriage and cohabitation).” Does this indicate that women in
arranged marriage do not cohabitate with their husband? Please clarify.
2. Please clarify that “literacy status” refers to the woman’s (not the man's)
literacy status through the text and tables.
3. Last sentence under first paragraph of Correlates of Sexual Coercion section –
shouldn’t this be 1-5 years, not 1-4 years?
4. The variable “support from family” is never mentioned in the text. Please
define what this variable means in both the text and tables. Does this mean
financial support?
5. Why did you decide to include variables in the multivariate model that were
non-significant in bivariate associations?
6. Typo in odds ratio of 4th sentence of 2nd paragraph of section on multivariate
analysis.
7. Last sentence of 2nd paragraph of section on multivariate analysis should be
“for instance” not “for instant”.
Tables
1. For male patriarchal control, low control should be defined as 1-2 rather than
as “<3”, since I assume no control means 0.
Discretionary revisions
1. 2nd sentence in abstract conclusion is confusing (and probably unnecessary):
“No single factor associated for the high prevalence of sexual coercion; many
factors contributed in this regard.” Revise or delete (also in conclusion section of
the paper).
2. 3rd paragraph of background: The authors may be interested in this reference
in regards to the effect of sexual coercion on abortion-seeking. Polis CB, Lutalo
T, Wawer M, Serwadda D, Kigozi G, Nalugoda F, Kiwanuka N, Gray R. Coerced
first sexual intercourse and lifetime abortion seeking among women in Rakai,
Uganda. International Journal of Gynecology and Obstetrics
2009;104(2):105-109.
3. Final sentence is not needed in the background section and would be more
appropriate incorporated into the discussion section or deleted.
4. The phrase “Life time experience of sexual coercion by their husbands” is
confusing as it sounds as though multiple husbands are involved. Could rephrase
as “ever experience of sexual coercion by a husband.”
5. For composite variables, consider using “index score” instead of “issues”, and
be consistent with that terminology for other composite variables. Include an
explanation for your cutoff values for these scores, if possible.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Not suitable for publication unless extensively edited
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.