Title: Is there a link between the autonomy of women and maternal healthcare utilization in
Nigeria? A cross-sectional survey
Version: 1 Date: 22 Sep 2022
Reviewer's report:
The study investigates the association between women’s autonomy and maternal health care
utilization. The analysis sample was obtained from the 2018 Nigeria Demographic and Health
Survey. Logistic regression models were utilized in determining the association. While the topic
is a welcomed contribution, there are some concerns I would like the author to address.
Introduction.
1. In the current form, the first paragraph contains lumped-up information, such as discussions
on statistical trends and the importance of MCH utilization. For better clarity, the authors should
split the section so that a single paragraph focuses on one specific talking point.
2. “Furthermore, women’s position has an impact on women and child health” (Last sentence
of paragraph two). In this sentence, “position” should be replaced with “status.”
3. “The association between maternal health care use and autonomy of women has not been
adequately explored, and many studies reported mixed findings on the association between
maternal health care utilization and autonomy of women (10).”
I beg to differ that the association between maternal health care utilization and women’s
autonomy has not been adequately explored. There are torrents of studies in this regard. It would
be helpful to readers if the authors could summarize what has been done and then identify the
current gaps and how their study will contribute. Also, while the author mentioned that studies
had reported mixed findings, it is expected to let the readers know what those findings are, and
the cited studies would be more than one (since a reference was made to “many studies”).
Method
4. I am not particularly convinced about how the authors have generated their outcome variable.
First, the choice of eight ANC visits should be supported by the relevant policy guideline. Based
on the author’s modality, someone with no ANC visit, no delivery in a health facility, and no
postnatal visit will be regarded as belonging to “0= no MCH utilization.” Consider someone
with 7 ANC visits; even though they have health facility delivery and postnatal visit, it means
they will also be grouped as “0= no MCH utilization.”
I think the best approach here will be either to analyze the three components individually or
employ a standardized method to convert the three components into a single composite measure.
That way, it will be treated as a continuous variable, interpreted as the level of MCH utilization.
PS: since the three components are not all measured on the same scale (it includes both binary and
continuous measures), a standardized method is needed to convert them into a single composite
index.
Result
5. The analysis shown in Table 3 has much vital information buried away. As Table 3 is a
bivariate analysis, each of the three components of MCH should be analyzed separately. This
way, information can be available on which component of MCH women utilized more or least.
This can be done regardless of whether the author uses composite or separate analysis in the
regression analysis. The footnote in the Table should also mention how the values have been
derived.
Discussion
6. “Even though women’s autonomy had a significant influence on maternal health care service
utilization in Nigeria (10,21), the findings revealed low maternal health care service utilization
(16,22). Low usage of health care services among women in Nigeria might be one of the reasons
for high maternal and child mortality (10).” (Last portion of the first paragraph).
It is unclear if the authors are discussing their results or other people’s work. Also, the
last sentence may need to be rephrased and presented from the perspective of the potential
consequences of inadequate utilization of MCH. In its current form, it looks a bit like a result
overstretch.
7. Perhaps, my primary concern with this manuscript is that the paper’s objective is not
sufficiently discussed. Given the article’s title and objective, the discussion on autonomy was
noticeably scanty both in the results and discussion sections. Not all the results of the control
variables need to be discussed; limit the discussion to a selected view. Your main discussion
should focus on the X and Y variables.
Others
8. The bibliography list needs proper formatting. Several essential and relevant citations have
not been included. The authors need to consult more peer-reviewed articles rather than relying
on random internet links.
9. The manuscript needs further editing for language and grammar fluency.