Title: Abortion and contraception within prison health care: A qualitative study
Version: 2 Date: 26 Aug 2024
Reviewer's report:
Thank you for the opportunity to review this important qualitative paper exploring the
experiences of those seeking contraception and abortion among women and gender diverse
people who have experienced incarceration in Canada. There are several issues that should be
addressed before publication, namely clarifying the study design and data analysis methods.
Introduction:
Consider adding some contextual information regarding abortion and contraception access in
Canada. For example, is contraception free, can abortion in Canada be accessed at publicly
funded facilities, are there cost barriers to access?
Design:
- Please provide a reference for community-based research, or the community-based research
framework that was used.
- You discuss partnering with community organisations in Canada and describe the specific
locations in the results. For those unfamiliar with these locations please indicate if they are all
metropolitan locations, or if some are based regionally.
- You note that expert advisors with lived experience of incarceration were involved in study
design and analysis. Was there any training provided to collaborators and expert advisors about
research design or thematic analysis? Were collaborators paid for their time?
- How were expert advisors with lived experience of incarceration identified and approached to
collaborate on this project?
- Considering this project was about women and gender diverse people who have experienced
incarceration it may be important to specify the gender of focus group interviewers and
potentially also the expert advisors with lived experience of incarceration.
Recruitment:
- You note that recruitment occurred through community organisations providing housing,
legal and/or practical support to people experiencing criminalisation. Can you comment on if
accessing any of these services was a requirement of release from prison, and if there may
have been any perceived or actual pressure to participate in this study if advertised by these
organisations. Were participants assured that whether they participated or not it would not impact
on their access to these services.
Data collection:
- Who was present during focus groups from the research team and other collaborators?
- How did the research team decide when to stop data collection?
- What steps were taken to ensure anonymity within the focus groups.
Data analysis:
- Please provide a reference for your analysis method (reflexive thematic analysis).
- Reflexive thematic analysis emphasises the importance of understanding the subjective
position of the researcher and how that may impact on the generation of knowledge during the
research process - please give a brief description of the main researchers analysing the data. E.g.
public health professionals with experience in sexual and reproductive health care provision,
expert advisors with lived experience of incarceration etc.
- Further describe how collaborators were included in the analysis process.
- What was used to analyse the data, e.g. NVIVO, manual coding, excel spreadsheet.
Results:
- Please note here who conducted the focus groups.
- Were any field notes taken during focus groups, and if so by whom?
- Indicate the length of focus group discussions.
- Consider adding some contextual information to prison specific terminology e.g. segregation,
shackling
- Under Theme 4: Health knowledge gaps you note SRH needs - please write this abbreviation
in full the first time it is used.
Limitations:
- Demographics were not taken, and researchers made deductive assumptions of the variability
of participants, including gender identity. This should be included as a limitation.
Conclusion
- You note that “even when released, barriers to care persist, such as discrimination from care
providers and restrictive requirements of bail or parole”. I agree your results clearly show
discrimination from care providers, but I’m unsure the results you have included in this paper
demonstrate how restrictive requirements of bail or parole specifically impact on sexual and
reproductive health seeking.