Reviewer ’s report  
 
Title: Eliminating the high abortion related complications and deaths in Cameroon. The 
restrictive legal atmosphere on abortions is no acceptable excuse.  
 
Version: 0 Date: 16 Dec 2016  
 
Reviewer: Erin Pearson  
 
Reviewer's report:  
 
This paper makes the case that despite the restrictive abort ion law in Cameroon, high maternal 
mortality from unsafe abortion could be reduced by increasing access to family planning and 
postabortion care (PAC), especially for adolescents.  
 
Major comments:  
1. As the authors note, unsafe abortion is high in Camero on despite the restrictive law, and 
studies have shown that abortion rates remain relatively stable regardless of the law (see 
Sedgh et al., 2012 in Lancet). Though law change does not impact abortion rates, it does 
impact the proportion of abortions that are unsafe. As a result, unsafe abortion will be a 
problem in Cameroon until the abortion law is liberalized and safe abortion services are made 
widely available. However, at the moment, the authors seem to dismiss the idea that the law 
could change, and p ropose ways to reduce maternal mortality from unsafe abortion despite 
the law. The argument would be more compelling if authors first discussed the role that law 
change could play in reducing unsafe abortion, and then make the case that until the law is 
changed, increasing access to FP and PAC can be an approach to reducing morbidity and 
mortality due to unsafe abortion.  
 
2. It would also be helpful to add more information on why the authors do not think the law will 
change given the high rates of maternal  mortality from abortion in Cameroon. There has been 
recent progress in places such as Malawi where advocates have been able to make the case 
for broadening conditions under which abortion should be legal given high rates of maternal 
morbidity and mortalit y. These law changes would likely have a greater impact on maternal 
mortality than the solutions proposed by the authors. It would be helpful to understand why 
this law change is unlikely in Cameroon and why efforts should focus on other types of 
intervent ions instead.  
 
3. The authors mention abortion stigma and lack of knowledge about legal conditions for 
abortion as major contributors to maternal death from unsafe abortion. The authors focus on 
health system recommendations, but information campaigns to r educe stigma and increase 
knowledge about the law could also be recommended.  
 
Minor comments:  
1. Abstract and Background section should include information on the abortion law in 
Cameroon. Does restrictive mean illegal on any grounds? Only to save the lif e of the 
woman?  
 
2. In the Background section, Page 3, Line 11, specify that 20 million unsafe abortions annually 
is globally, not only in Cameroon.  
Are the methods app ropriate 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 manuscript or would you recommend an  
additional statistical review?  
If an additional sta tistical review is recommended, please specify what aspects require further  
assessment 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 lang uage 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 t his 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 applie d 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?  
 
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below.  If your reply is yes to any, please give details below.  
 
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