Reviewer’s report
Title: 
Methods women use for induced abortion and sources of services: insights
from poor urban settlements of Accra, Ghana
Version: 
1 
Date: 
06 Apr 2021
Reviewer's report:
Caesar Agula and co-authors describe methods used for induced abortion in
Accra, Ghana. 
Overall, this is an excellent manuscript. It is well-written, clear, and informative,
and addresses an important topic with healthcare and policy implications. I have
several minor suggestions to strengthen the manuscript: 
Methods:
For readers not familiar with Ghana, it would be helpful to say that Ghana is a
West African or SSA country and define Accra as the capital city. 
If available, the justification for why these two communities were selected for
WIE would be helpful to understand generalizability. Are they representative of
poor communities in Ghana? Or chosen because they are especially
disadvantaged? 
I recommend adding a clear statement of inclusion criteria for this specific study
to distinguish it from the general WIE participants. 
If available, it would be interesting to know the proportion of women in WIE
who responded yes to having has an induced abortion and thus were included in
this study 
It was a little confusing to start the methods describing both "survey" and
"interview" -- it left me wondering if there were two separate data collection
components.
A few ethical details: Was language and location of interview selected by the
participants? Was consent written? Include IRB #s. 
How was the wealth index defined? Perhaps add a footnote. 
The writeup of the regression results is a little unclear. I think the paragraphs
need topic sentences clearly stating that the first paragraph describes factors
predicting MA versus surgical abortion, and the second paragraph describes
factors predicting MA versus non-medical abortion. The "less likely" framing
also made it harder to understand. Sentences like "Using women aged 40-44 as
the reference group, all younger women aged 16-39 years had less relative
likelihood of using a surgical procedure to induce abortion compared with MA"
could be reframed as something like "Compared to younger women aged 16-39,
older women aged 40-44 were more likely to use ___". 
The info is there, but I
found myself needing to read this section multiple times and lost the points. 
In Table 2, adding a "*" or something to denote significant values would be
helpful. 
Figure 1 is very well done and conveyed the message of change over time
clearly. Figure 2 is also important, but I recommend reformatting since the
percentage numbers on the bars are hard to read. 
Generalizability to other areas in Ghana and other countries in SSA should be
added as a limitation. 
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
Yes
Declaration of competing interests
Please complete a declaration of competing
interests, considering the following questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I declare that I have no competing interests.
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
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?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes