Reviewer's report
Title:Induced abortion trends from 1996 to 2011 in Estonia: special emphasis on
repeat abortion
Version:1Date:17 May 2014
Reviewer: Boris P Denisov
Reviewer's report:
Minor Essential Revisions
1
Despite the high abortion rate during the Soviet Union period [1], abortion was
stigmatised and was not the subject of any public debate.{lines 58-60}
This is incorrect for the SU as a whole, abortion was not stigmatized in the SU,
some researcher even talk on “abortion culture”, public debate was not common
for the USSR, but experts' debate had been quite lively. If author speak on
Estonia, this should be explicit.
2
Indeed, statistical data on abortions have been routinely collected by the
Estonian Abortion Registry (EAR) since 1996 [2]. {lines 64-65}
A reader might ask about the previous data collection system. Few words would
be enough to underline that there are data before 1996. Moreover, there is no
word in the paper on spontaneous abortions/miscarriages. Since Estonia had
Soviet system of data collection (probably till 1996), and the Soviet system
collected data on pregnancy terminations, which included miscarriages a reader
must be sure that induced abortion are really induced, and exclude spontaneous.
3
repeat abortions may be associated with adverse outcomes in future pregnancies
{lines 77-78}
they may, and they may not also
4
{lines 127-131} age specific rates should precede TAR
5
{lines 133-137} isn't it possible to provide urban/rural break up?
6
During the same time period, the total abortion rate dropped from 1.72 to 0.71
(data not shown). Alongside this consistent decline in the number of induced
abortion there was a 22.9% increase in fertility rate.{lines 159-161}
per thousand rates shown on a fig 1 are less interesting than TAR and TFR, the
latter do not depend on age structure, thus are better indicators + gridlines
especially AR=1 will make the picture more descriptive
7
table 1
the last column (change in percentage) should be better introduced (with the
formula) or omitted since its utility is doubtful
8
Contraception non-use prior to abortion accounted for nearly two thirds 187 of
women having a repeat abortion; while the use of contraceptive pills and
intrauterine contraception was low at the time of first, second, third or fourth or
subsequent abortions (Table 2).{lines 187-189}
Most women did not use any contraceptive method prior to their first or
subsequent abortions. {lines 209-210}
it is really a strange and unexpected result – I would like to see more discussion
about it
9
We can conclude that the majority of abortions in Estonia did not follow
contraceptive failures, but occurred because of contraceptive non-use. This
confirms that the availability of and access to contraception is not enough to
lower the incidence of unintended pregnancies. {lines 306-309}
Seems like the first sentence contradicts to the second one
10
There remains a significant unmet need for contraception use, and
non-Estonians, women with lower educational attainment, students and women
with children represent particularly vulnerable groups. {lines 306-309}
The paper does not provide an estimate of unmet need, this could be performed
in the future, although I'm not sure EAR allows its calculation.
Discretionary Revisions
1
# 19 or -19 is better than 15# 19
2
In Estonia, the level of legislation appears to correlate with abortion accessibility
during a long period of time. {lines 52-52}
I prefer: abortion accessibility correlates with legislation (not only in Estonia)
3
Specific efforts to reach adolescents and young people have been made – in
1991, the first youth counseling centre was initiated to address sexual health
issues and contraception, increasing to 20 centers by 2011 [13,15].
please, reformulate, e.g., by 2011 the number of the centers increased up to 20.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I have no competing interests