Title: Partner involvement in abortion trajectories and subsequent abortion safety in Nigeria
and Côte d’Ivoire
Version: 1 Date: 13 Feb 2022
Reviewer:  Raffaela Schiavon
Reviewer's report:
GENERAL COMMENTS.
The article topic is interesting.
The methodology and the statistical analysis are well described, technically sound and well
carried on.
However, overall, the article seems too  long,redundant and repetitive. I am sure it would benefit
in being more succint (Background, Results and Discussion), paying particular attention in
avoiding repetition of the same concepts/results, sometimes in confusing and complementary
manners: for example, you sometimes report and compare % reduction of aOR  with absolute
aOR: see lines 384-400 of Discussion.
This type of writing often obliges the reader to an unnecessary and tiring  mental gyms, with the
risk of loosing the  more important and general view.
MORE COMMENTS.
1) Do you describe only INDUCED ABORTIONS, correct? The questions of the PMA
questionnaire are clearly able to exclude SPONTANEOUS ABORTIONS/miscarriages? Please,
clarify this from the beginning
2) Could you just say less unsafe vs. most unsafe abortion? The concept is pretty clear; saying
“not most unsafe” does not add much, and is kind of weird….
3) When defining safety/unsafety and less unsafe/most unsafe abortions, I have one specific
recommendation: please explain how you define - in the statistical analysis and the results
sections - which types of methods and which types of providers you do include in your
codification. In Table 3, one can GUESS that you classify as safe methods the use of surgery
plus mife/miso, and as safe providers the public and private facilities. Is it correct?  However,
you never explain this clearly in the text, just suggesting it in the foot notes of the Tables.   I
also wonder why you don´t build a composite index (methods PLUS providers) that could have
the advantage of wholly expressing safety/unsafety of the procedures. This could additionally
avoid the problem of some very small samples in Cote d´Ivoire (CdI).
While clarifying your criteria/definitions for safe/unsafe abortions may seem unnecessary to a
reader who is expert in the field (see B. Ganatra et al in the References) it is NOT obvious to
everyone.  And it could also be considered subjective and/or questionable, according to most
recent WHO criteria and its vision of Task sharing in abortion care, where pharmacies could
be included among "safe" providers. And please, keep referring to B. Ganatra article when you
describe most unsafe abortions, you often say OUR definition.
RESULTS (INCLUDING TABLES)
Please, referring to Figure 1 (Flowchart), describe in the text (and add in the table itself) the % of
surveyed women who declare having experienced an abortion. While it is NOT clearly the scope
of the paper to measure/estimate the prevalence of induced abortion in your populations, it can
add some sense of plausibility, representativity and comparability of your samples of women
with international statistics.                                                                                                                                 Related to
Table 1, I suggest you add some short lines when describing characteristics of women reporting
abortion, comparing them in the two countries (Nigeria and CdI:  and add a p?). They seem
pretty different to me. Line 323-327: Please, always use the same order/sequence in presenting
your results: Nigeria first and CdI afterward. It is easier for the reader to follow the presentation
of results.
Lines 342-349. It is redundant and somehow confusing to the reader. Can you clarify and
simplify?
In the text, you don´t describe the “Abortion characteristics” presented in Table 4; however,
it is unclear to me what are you presenting here (the distribution is already there in Table 2).
I can´t understand what type of analysis are you presenting (bivariate?) since you are comparing
less unsafe/most unsafe with your definition of safety of methods/providers. Or do you have
another way to measure safety/unsafety???
Line 370-377: I suggest you try to be more synthetic, you have the tables to present all the details.
Line 377-379: Another example on how the reader may be confused by the multiple way you
describe the same results: aOR of most unsafe abortion: Nigeria: aOR= 0.25… CdI=0.22. You
never present the data this way, the reader must his/her own (even if simple) calculations to get
to those aOR.
DISCUSSION: Again, I find it pretty redundant. You present again your results in too much
detail, and in complementary ways (see lines 397-400). Please, resume them, reaffirm only
the most relevant, and be consistent in the way you present them in this section. You could
make definitively shorter (and easier to read) the sections in Lines 410-423; lines 426-435; lines
443-452 and lines 481-493)
Additionally, I would question the assumption that you describe in the discussion (lines
429-439): that the involvement of the partner is synonymous with assuming the responsibility
for the pregnancy. One could question that it is the other way around: NOT assuming the
responsibility for the pregnancy would result in a partner´s involvement with any process
related to an induced abortion (as you yourselves mention in Lines 463-466 and ratify in the
conclusions). Does the PMA questionnaire help in understanding this potential interpretation?
LIMITATIONS: Definitively, the main limitation of the study is women´s self-report (I suggest
you mention it first), the time span of the study and the proportion of women lost-to-follow-up.
Moreover, characteristics of women who completed the survey vs. those who were LFU (Lines
512-519) should be included in the Results section.