Reviewer’s report
Title: A Qualitative Study on Reasons for Early Removal of Implanon among Users in Arba Minch
Town, Gamo Goffa Zone, South Ethiopia: A Phenomenological Approach
Version: 1 Date: 23 Apr 2019
Reviewer: Emmanuel Morhe
Reviewer's report:
This qualitative study sought to use phenomenal approach to explore reasons for early implanon
removal among users in Arba Minch town, South Ethiopia. These comments are on the revised version
of the manuscript. 
I commend the authors for their effort. However, the reviewer comments have not been satisfactorily 
addressed.
i.      Beyond the definition, reasons for choosing phenomenal approach and steps taken in its 
application in the conduct of this study have not been stated.
ii.     Information on duration of implanon use is fundamental information required in the 
inclusion/exclusion criteria or presentation of the profile of participants of this study that set to 
determine clear understanding of reasons for unusual early discontinuation of implanon.   
iii.    Stating "purposive and convenience" selection of participants without further explanations do not 
provide clarity about the few implanon users whose experiences the study seeks to explore.  
iv.     Page 5 line 37 -47 is still unclear. In family planning practice long-term reversible (IUD and sub-
dermal implants) methods usually used for birth spacing should not be lumped up with permanent 
methods (male and female sterilization) that are used for birth limiting.
v.      The study revealed well known reasons for implant discontinuation. These include side effects, 
desire for more children, male partner opposition, 'method failure' and informed decision making 
process. However in-depth exploration of these reasons, a primary objective of the study has not been 
done. 
vi.     Furthermore irregular menstrual bleeding, the leading reason for discontinuation of sub-dermal 
implants has been well documented in many settings including Ethiopia. In practice implanon causes 
scanty and irregular menses. Thus, indicating that most users discontinued the method for perceived or 
observed heavy menstrual bleeding requires further exploration to have a clear understanding of this 
important concern of the local users of the method. 
vii.    Similarly, desire for more children, male partner opposition. Specifically what really constitutes 
male opposition?
viii.   Also, implanon is one of the most effective contraceptives. Hence, experiencing 'method failure' 
require further interrogation.  While on implanon have any of the participants experienced unintended 
pregnancy? What really happened?  Regarding HEWs who reported attending to clients with method 
'failure', what really were the associated factors?
ix.     Making voluntary informed choice and form of counseling provided require exploration 
x.      In conclusion, the study has not adequately addressed the set objective 
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
No
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you recommend an additional
statistical review?
If  an  additional  statistical  review  is  recommended,  please  specify  what  aspects  require  further
assessment in your comments to the editors.
Not relevant to this manuscript
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
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