Reviewer ’s report  
 
Title: “Regardless, you are not the first woman”: An illustrative case study of contextual risk 
factors impacting sexual and reproductive health and rights in Nicaragua  
 
Version: 1 Date: 02 Oct 2017  
 
Reviewer: Lisa Haddad  
 
Reviewer's report:  
 
Overall this is a beautifully written piece on a very tragic story of a young woman with clear 
lessons learned that are applied within a publ ic health framework.  
 
For the abstract  
 I feel the order of the abstract is not really appropriate. The Case itself should be in the results 
section along with the details of the themes that are brought up. The method on case studies as a 
lens is better f or the introduction. Additionally I would state that you present the historical 
context in Nicaragua  
 
Introduction  
- line 77 - this paragraph would be better if starting with the 89% then breaking it down to 
the proportion that received 1 type, 2 or 3 typ es of VAW.  
 
- On line 93 - while it is true regardsing WHO technical statement, the discussion of 
Nicaraguan history should be the center of this section with the WHO guidance 
statements adding to the discussion later. This can be expanded on in the discuss ion to 
include national recognition of the impact of restrictive laws  
 
- Also would consider moving the sentences from 91 to 94 down to after you mention the 
abortion law starting at paragraph from 117.  
 
- Similar to the statement regarding the WHO, the par agraph starting at 126 is excellent 
commentary that feeds into the prevention of this outcome that the case elucidates. This 
would likely be better included in the discussion with this statement really specific to 
painting the story of Nicaragua.  
  
Methods  
- Are the details from your other interviews available anywhere.  Was interview taped and 
transcribed? Who conducted the interview? How were the women recruited?  
 
Discussion  
- Really beautifully written. You can include more detail on national efforts in  the context 
of reducing the impact of unsafe abortion  
Are the methods appropriate and well described?  
If not, please specify what is r equired in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
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 manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects req uire further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
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