Title: Prevalence and factors associated with sexual and reproductive health services use among
reproductive age women with disabilities: a community based cross-sectional study
Version: 4 Date: 07 Jan 2023
Reviewer's report:
This is an interesting article and an important contribution to the literature concerning the
reproductive health of women with disabilities  in Ethiopia. The authors contextualize their
study within the related literature. However, the manuscript requires an extensive copy-edit to
be acceptable for publication.
Recommendations and questions as follows:
Abstract:
Background: change “SRH outcome” to “SRH disparities”
Results and Conclusions: The study findings are repeated in the Conclusions; the conclusion
should sum up the key findings and discuss their implications.
The manuscript requires a copy-edit for English language, as some of the sentences are run-on,
choppy, or include unnecessary words.
Introduction
- Please do not use the language of “handicapped” as this is dated and stigmatizing language
concerning disability
Methods
- It is unclear what the numbers in parentheses mean after the names of the woredas?
- How was disability measured? Did participants self-identify as having a visual, hearing, or
physical impairment or was it required that they have a diagnosis of disability to participate
in the study? Please justify the inclusion of these three disability groups (what about women
with intellectual/developmental disabilities?). Please provide more details concerning the
Washington group for disability statistics.
- The data source for SRH services is somewhat unclear – “can be obtained by the women from
pharmacy, health institutions (private or governmental), community-based distribution or some
other sources”  – was this administrative data or self-report data?
- More details are need about the data collection tool; it is not enough to say that it was adapted
from other literature.
Results
- If many participants were unable to read and write, how did they consent to participate in the
study? Details concerning the informed consent process are needed.
- Was there income level data collected? Knowing a participant was a government employee
does not indicate their level of income/socio-economic status. Would it be possible to provide
more information concerning the rough income of each of the employment types?
- Did any participants have female partners? Did all identify as heterosexual?
- Does number of live children refer to number of children birthed/live birth or could this also
include step or adopted children?
- Lines 242-243 are somewhat unclear – unclear what organizations refer to based on how the
sentence is written
- How was autonomy measured?
- Is the decision-making variable broad, to include any decisions, or just decisions pertaining
to SRH?
- Did participants note other methods of contraception such as abstinence (not engaging in sexual
activity) or natural methods like tracking ovulation?
- Figure 1 is not needed
Discussion
- This section, like the others, needs a copy-edit for English language writing and consistent
formatting, e.g., visual impairment does not need to be in brackets in line 379
- Interesting and important finding re: differences between those who live with partners versus
parents; this study is a novel contribution citing this contextual factor – who disabled women
live with and social norms – these may have important implications for their SRH
- The language used in lines 439-444 is too colloquial.
- A greater discussion of the implications for the SRH of women with disabilities is needed in
the discussion.
More recent research, including population-based research, concerning the reproductive and
perinatal health outcomes of women with disabilities can be cited throughout the article to
provide context, e.g.:
- Tarasoff, L. A., Lunsky, Y., Chen, S., Guttmann, A., Havercamp, S. M., Parish, S. L., ... &
Brown, H. K. (2020). Preconception health characteristics of women with disabilities in Ontario:
a population-based, cross-sectional study. Journal of Women's Health, 29(12), 1564-1575.
- Tarasoff, L. A., Ravindran, S., Malik, H., Salaeva, D., & Brown, H. K. (2020). Maternal
disability and risk for pregnancy, delivery, and postpartum complications: a systematic review
and meta-analysis. American journal of obstetrics and gynecology, 222(1), 27-e1.
- Panko, T. L., Cuculick, J., Albert, S., Smith, L. D., Cooley, M. M., Herschel, M., ... & McKee,
M. (2022). Experiences of pregnancy and perinatal healthcare access of women who are deaf: a
qualitative study. BJOG: An International Journal of Obstetrics & Gynaecology.
- Horner-Johnson, W., Akobirshoev, I., Amutah-Onukagha, N. N., Slaughter-Acey, J. C., &
Mitra, M. (2021). Preconception health risks among US women: Disparities at the intersection
of disability and race or ethnicity. Women's Health Issues, 31(1), 65-74.
- Horner#Johnson, W., Dissanayake, M., Wu, J. P., Caughey, A. B., & Darney, B. G. (2020).
Pregnancy intendedness by maternal disability status and type in the United States. Perspectives
on Sexual and Reproductive Health, 52(1), 31-38.
In other words, even in North America and Europe, women with disabilities experience SRH
disparities. Contextualizing the study findings in the current context is important however
and a novel contribution to the literature concerning the reproductive health of women with
disabilities.