Reviewer’s report
Title: 
‘Making of a Strong Woman’: A constructivist grounded theory of the
experiences of young women around menarche in Papua New Guinea
Version: 
2 
Date: 
08 Nov 2020
Reviewer's report:
Review: November 2020.
BMC Women's Health: 'Making of a Strong Woman': A constructivist grounded
theory of the experiences of young women around menarche in Papua New
Guinea'.
Dear Editors and Authors, 
Thank you for the opportunity to review this paper in the spirit of making this
manuscript more robust. The authors highlight the important study area of
identifying and exploring women's understanding of menarche in Papua New
Guinea.
I have been asked to review this work in my capacity as a public health midwife
and qualitative researcher who has focused on reproductive health decision
making in the low-middle income nation of Timor-Leste. Given my research
experience is in ethnographical, decolonising qualitative study designs, I will
leave specific feedback around a constructivist grounded theory approach to
those with experience and knowledge in that field.
This paper requires some revision and improvements in readiness for
publication. Please see below for my comments and feedback for each section: 
Abstract:
* The line in the 'Conclusion' - "However, traditional cultural practices provide
an opportunity for collective support and focused learning for girls", I think is
one of the most important lines in your paper……it would be pleasing to see you
discuss this concept, with its inherent complexity, in much more detail in your
paper.
Background:
* Page 4 Line 34 "Social and cultural norms……" - this line just needs
rearranging….it sounds like it only impacts those who live in rural and remote
areas.
* It would be pleasing to read in a little more detail about the motivation for this
study and the authors' interest.
Methods:
* Page 9 Line 3 - nominated age range of participants….how was this
determined? On what was this based?
* Maybe within the methods section provide a definition/explanation of what
you mean by the term 'naïve girl' that you use later in your manuscript.
* Page 10 Line 47 - some more detail around the conferences and feedback from
PNG women would be useful here.
* It would strengthen your work to include a deeper discussion around
theoretical underpinnings to your study here.
Ethical Considerations:
* Page 11 Line 12: perhaps soften this a little, for example: "Women unable to
sign (for example, some older women or women who were illiterate)….
* Page 11 Line 18: re info and consent forms - you highlighted previously in the
paragraph illiterate women - what allowances did you make for them in terms of
accessible information regarding the study and impacting on their ability to
provide informed consent?
Results:
* Page 11 "naïve girls" requires explanation 
* Page 11 "private body parts" - requires explanation/definition of what you
mean.
* Page 16 
as above
* Page 16 line 25 their childhood is repeated
* Page 16 line 41 - the first sentence of this paragraph needs rearranging for
clarity
* Page 18 Line 1 - "educated parents were in a better position"….what do you
mean here?
* Page 19 Line 12 spelling
* Page 20 line 17 - "scolding and swear words" - an example would be good
here.
* Page 20-21 the last paragraph beginning on page 20 and going through to line
37 on page 21 requires editing for clarity. There are many important ideas and
concepts in this paragraph but they just need to be rearranged to ensure clarity.
* Page 22 Line 18 - sentence structure/missing word
* Page 22 Line 39 - extra bracket
* Page 24 Line 8 - missing word
* Page 25 Line 23 - spelling; Line 38 - segue between sleep and Grandmothers.
* Page 27 Line 7 - grammar/sentence structure; line 13 spelling; line 18 moddess
- explanation required; Line 18 - missing word (Putting soiled pads in rubbish);
line 32 - missing word.
* Page 28 - I wonder if moving paragraph 3 (line 44) to become the second
paragraph on page 29?
* Page 29 Line 47 - "for long period of time" requires more detail/explanation.
* Page 31 Line 10 - the section beginning "Several young women…." Requires
some editing for clarity
Discussion
* Page 32 Line 2 "….and the value placed on girl children" - I did not pick up on
this in your results section.
* Page 33 Line 45 "…..sexually transmitted infections" - I did not pick up on this
in your results section
* Page 34 line 20 - "The conduct of such rites of passage……" This is such an
important component of your work but would benefit from a little more
discussion and clarity.
Conclusion
* Page 36 line 52 - "However, the cultural processes….." as I previously stated, I
think is one of the most important lines in your paper……it would be pleasing to
see you discuss this concept, with its inherent complexity, in much more detail
in your paper.
Thank you again for the opportunity to review this paper and I wish you every
success with your future research endeavours. 
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
No
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
No