Reviewer ’s report  
 
Title: Frequency, risk factors, and complications of induced abortion in ten districts of  
Mada gascar: results from a cross -sectional household survey.  
 
Version: 0 Date: 18 Sep 2019  
 
Reviewer: GODWIN O AKABA  
 
Reviewer's report:  
 
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The study is quite relevant to understanding contextual l issues relating to unsafe abortion in 
Madagascar. It also highlights the magnitude of uns afe abortion in that country as well as similar 
and even higher burden in other countries with similar restrictive abortion laws  
The article has been well written and the methodology and analytical approach are sound and 
conforms to best practices in cond ucting a community survey and estimating incidence of 
abortion.  
 
The results have also been well presented.  
Discussion: This has been well written but for observations below  
 
Page 16: Lines 6 -7 and lines 12 -14 
This study shows that abortion methods in Madag ascar remain mostly invasive with usage  
7 of misoprostol uncommon relative to other settings like Latin America21,22.  
Abortions performed by qualified medical personnel often involved curettage or insertion of 
objects into the genital tracts, and did not a ppear to result in fewer infections, suggesting such 
personnel lacked the training or equipment necessary to ensure patient safety.  
Comments:  
 
It would be more appropriate to compare with other countries in Africa with similar restrictive 
abortion laws also . 
 
The above findings should also help the authors to prefer recommendations on interventions that 
would build capacity of health care providers on comprehensive abortion care.  
 
Limitations to the study  
 
Abortion being a quite sensitive issue may not evoke a positive response from some of the 
women accounting for the low rate reported in this study.  
 
 
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 manuscript 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 am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscr ipt: 
 
Acceptable  
 
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