Reviewer's report
Title:Experience of gender-based violence among young pregnant women in
urban slums of Kathmandu Valley, Nepal: A qualitative study
Version:2Date:26 August 2015
Reviewer: Maya Ragavan
Reviewer's report:
Major compulsion revisions:
Overall comments:
1. I feel that the authors need to explain why this study is novel, exactly how it
pushes the literature ahead, and what is gained from this study that other studies
do not have. The introduction and discussion do not make this point apparent.
2. I also am torn about the use of gender-based violence which is incredibly
broad and includes perpetrators who are not intimate partners. The results
section focuses mainly on physical, sexual, and psychological intimate partner
violence. It may be helpful to reframe this study as one about intimate partner
violence or domestic violence rather than gender based violence.
3. Finally, there are some ethical issues that need to be better explained as
described below.
Introduction:
4.Overall, I feel like the introduction can be rewritten to discuss how exactly this
article is new. For example, it was not until I read the methods and results that I
realized this was about young pregnant women’s perspectives specifically about
intimate partner violence. The introduction should starts with what is known,
followed by what is less known, and what the article hopes to accomplish.
5. In the first paragraph, it may be helpful to cite literature showing the physical
and mental effects of GBV on health (not only sexual health).
6. In the second paragraph, there seem to be multiple statistics about different
aspects of GBV. Perhaps an explanation of why these particular statistics were
chosen would help make that paragraph more coherent as right now it is difficult
to ascertain exactly why those statistics were chosen.
7. In the third paragraph, there should be some sort of transition as to why you
are now discussing pregnancy as well as statistics on prevalence of GBV during
pregnancy.
8. Again, in the fourth paragraph a transition would be helpful. I don’t understand
why the authors suddenly started talking about dharma. I agree that it is an
important point to make but how does it fit in to the overall purpose of the
introduction.
9. In the fifth paragraph, more work needs to so how this study is unique. There
are multiple studies in low-income and developing countries looking at women’s
perspectives on intimate partner violence (which is what it seems this article is
about). How is this different? The fact that we are examining perspectives of
pregnant women is unique and should be included.
Methods:
10. In the study setting section, the authors say that 25 women were approach, 3
declined, and 20 participated. What happened to the other 2? Additionally, what
are “local clubs.”
11. How did you protect women’s confidentiality if community leaders were
approached to help develop participant lists? How did you know the community
leaders were sympathetic to the study and would not alert the partner about the
nature of the study?
12. There should also be a section on how the interview guides were developed.
Generally, with qualitative research, questions are developed using a theoretical
approach and then pilot tested to ensure participants understand the questions.
Was this performed? It would also be helpful to have a sample of questions, or
the interview guide as an appendix.
13.Ethical consideration section: What happened if someone interrupted the
interview or if a woman stated she did not feel safe? Was there a protocol in
place if a woman disclosed that she was a survivor of GBV? It appears like the
majority of women stated that they were or are in an unsafe situation. Were any
resources provided to these women?
14. In the indepth interview section: Please expand on how you used the WHO
Ethical Guidelines.
15. It appears that some of the individuals you interviewed were under the age of
18. Were there any specific ethical considerations for children under the age of
18. If not, please explained how you protected their rights.
Results:
16. The first section of the results seems redundant from what is presented in the
table. Perhaps you can cut this down to the most important facts and that would
leave room to include more quotations later on in the results section.
17. Usually with qualitative research, there is an introductory paragraph that
describes the key themes you will be discussing. Adding that paragraph would be
helpful.
18. The quotations chosen are very appropriate and highlight the immense
trauma these women have experienced. Why did you not choose quotations for
the last three sections in the results section? It would be helpful to have
representative quotations here as well. I feel like the last three sections are
unique and very rich so it would be helpful if the authors expanded on these
sections.
Discussion:
19. The organization of the discussion section confuses me. It needs to be
organized to bring out two or three key points highlighted in the results section.
I am still unclear as to the novelty of this particular study. Many of the points the
author discusses in the discussion section have been reported before, especially
in regards to violence in the setting of patriarchal norms. I think this study is
unique because it examines the perspectives of pregnant women however this is
not discussed.
20. The second and third paragraphs are very interesting but belongs in the
introduction. In the discussion, the authors should results from the study and
relate it to the literature. Both paragraphs brings up new ideas and seems out of
place. I am not sure I understand the relationships between these paragraphs
and the results from this manuscript.
21. It would be helpful to have a section dedicated to recommendations and
areas for further research. Qualitative research is often used to build theories
which then can be tested. What research or public health interventions could be
suggested from the results of this article?
Tables/Figures
22. In table 1, there needs to be explanation about some of the terms, including
caste, types of marriage, and types of family. I understand what they mean but
an international audience may not.
Minor revision
23. I don’t personally think Figure 1 adds anything and could be removed.
Level of interest: An article of limited interest
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests