Reviewer ’s report  
 
Title: Contraceptive use and determinants of unmet need for family planning; a cross sectional 
survey in the North West region, Cameroon  
 
Version: 0 Date: 29 Jan 2018  
 
Reviewer: Deborah Bateson  
 
Reviewer's report:  
 
Given the lack of data from this region of Cameroon I believe this paper is important to publish, 
especially as it will help in allocation of resources as pointed out by the authors. By necessity 
there is a certain lack of originality in the approach and t here is some room for improvement and 
clarity, especially around how unmet need for contraception was calculated. I have some points 
for consideration:  
1. While I understand this information was not included in the survey, I think readers would 
benefit fr om some contextual background information about how contraception is provided 
in this region, by whom as well as what type of contraceptives are available - implants and 
IUDs are mentioned but we don't know whether they are accessible, promoted or who inse rts 
them for instance. The authors importantly conclude that improved training of providers 
would be beneficial in relation to improving their 'competence'  - again, even though the 
authors point out that this is beyond the scope of the study,  some inform ation on current 
training would be helpful to allow for an understanding of supply and demand for 
contraception.  
 
2. It would be beneficial to reference the UN guidance for calculating unmet need for 
contraception - which is acknowledged by the UN as a com plex calculation. Unmet need, as 
the authors state, is divided into unmet need for limiting or for spacing pregnancies - it is a 
little unclear if the authors are including women whose current /last pregnancy was 
unplanned (i.e. a retrospective definition)   in the calculation (see Operational Terms)  which 
would be unusual. More detail is also needed on amenorrhoeic status (while the authors refer 
to non -gestational amenorrhoea of 1 year, the definition of post -partum amenorrhoea (i.e. 2 
years) has not been  referred to in the definition of infertility (or in -fecundity)).  
 
3. The methodology is well described - the 'tossing of a plastic bottle' is novel to me but I will 
leave it to a statistician to comment on its appropriateness in this setting.  
 
4. There is a high proportion of Christians in the sample - it is important to know if these are 
mainly made up of women practicing Catholicism as this may influence contraception?  
 
5. The role of the partner has been highlighted well but it may be useful to elaborate on the 
concept of 'disapproval by the partner' - there is no mention of reproductive coercion or 
gender -based violence - I realise it may be not relevant in this society and/or there may be 
lack of data but it may be important to draw out? While men undoub tedly play an important 
role perhaps women's autonomy in contraceptive decision -making needs to be further 
explored - and what about women with no male partner (again having a (brief) 
understanding the local context in relation to marriage, children out of  wedlock etc would be 
helpful although I understand this may be beyond the scope of the article). Education for 
both women and men would seem to be an important point.  
 
6. It may be useful to include information about abortion - in the case of contraceptive  non-use 
or failure do women resort to unsafe abortion in this region?  
 
7. Line 72 in Background and Rationale - the term 'recycling of personnel' is not clear - does 
this mean rapid turnover?  
 
8. It would also be useful to have some clear recommendations ab out how to improve unmet 
need, especially if influence on the allocation of funding is a desired outcome of the paper  - 
this could be from a data, educational, family planning provider and supplies perspective in 
the discussion even though the latter were  not included in the survey.  
 
9. Funding information is required.  
 
Overall this is an interesting and important paper and I look forward to the future surveys 
amongst men in this area but also to surveys about women and how to support their autonomous 
decision-making.  
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Are the methods appropriate and well described?  
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No 
 
  
Does the work include the necessary controls?  
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Yes 
 
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Yes 
 
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I recommend additional statistical review  
 
Quality of written English  
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Needs some language corrections before being published  
 
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