Reviewer ’s report  
 
Title: Contraceptive experience and perception. A survey among Ukrainian women.  
 
Version: 0 Date: 30 Apr 2017  
 
Review er: Made Laanpere  
 
Reviewer's report:  
 
Thank you for tackling this important topic. It is important to analyze knowledges and barriers 
for contraception use to make appropria te interventions in Ukraine.  
I have some comments and suggestions that are both general and specific that I hope you will 
consider.  
 
General comments  
Introduction outlines appropriately the problem investigated, but is rather superficial and 
sometimes not supported with valid evidence. It needs to address more to explaining the trends 
of the main reproductive indicators - birth and abortion rate. The article would benefit from some 
discussion of the access to contraception, what methods are available, the h ealth insurance 
coverage for contraceptives and access to contraceptive services.  
Methods are inadequately described. Especially the main outcome need more detailed 
description - what does mean "contraceptive experience" (R99)? The exact questions need to  be 
presented in the paper. Is it the contraceptive method used during the lifetime, during the last 
intercourse …? Was it possible to give only one answer or more? Was the list of methods for 
respondents available? It is popular to use dual method (for ex ample: condom and other among 
young people) - how it was addressed in your study? Contraceptive knowledge - it is very hard to 
understand the outcome if the exact question is missing.  
The number of ethical permission is absent and need to be added.  
 
Result s are described rather unsystematically. In case there are figures, exact numbers, 
percentages should be presented in the text (R114 -117) - these data are your main outcome.  
Even the paper do not have discussion about side effects and myths about contracep tion, it 
should be mentioned that the most of side effects, reported by respondents, are not causally 
related to contraception - even more, some of them are treated with hormonal contraception (for 
example irregular bleeding, acne, PMS  etc). Therefore, ra ther to say "experienced by women" it 
is more correct use wording: "reported by respondents" throughout the paper.  
Table 4 presents anecdotal fears (absence of menstruation in the future, infertility, acne, weight 
gain) which are not discussed in paper -it needs to be addressed in the text or leave this table out.  
 
Discussion should address the main results the first. LARC seems to be the main outcome 
according the discussion, although it is not mentioned in the introduction as well as wasn´t 
mentioned amo ng outcomes.  
It is interesting to know that use of IUD is very low in Ukraine. The steep decline of IUD use is 
also noticed in Russia (Perlman F, McKee M. Trends in family planning in Russia, 1994−2003. 
Perspect Sex Reprod Health 2009;41:40−50). This trou blesome trend might be associated partly 
with provider's attitudes: in qualitative study (Larivaara M. Pregnancy prevention, reproductive 
health risk and morality: a perspective from public -sector women's clinics in St. Petersburg, 
Russia. Critical Public Health 2010;20:357−71)described gynecologists' opinions according to 
which IUD  was considered a problematic choice even for married women because of fear about 
husband's infidelity and consequent STI.  
 
Specific comments:   
R29 It sounds strange to call women who have had an abortion or a delivery as „women with 
proven ferytility". Had been pregnant does not mean that the fertility is guaranteed or „proven" 
as infertility period (s) may be followed. I suggest not to use this wording, but instead: recently  
pregnant women or women who had an abortion or a delivery.  
R 54 -57 Alkema et al paper cover also data about Ukraine (in page 1647) - you may consider to 
present not only worldwide data , but data about Ukraine.  
R 58 -63 Decribing the contraceptive preva lence and unmet in Ukraine in 2012 - reference is 
needed  
R 63 -67 Description of indicators should be presented before the data (in the beginning of 
introduction.  
R 67 What is „fertility target"? The wellknown indicator: total fertility rate (TRF) - the nu mber 
of births a woman would have by the end of her reproductive life if she experienced the currently 
prevailing age -specific fertility rates from age 15 to 49 years. TFR between 1 and 2 have very 
different meanings, as 1 is very low and 2 is almost of th e population´s replacing level of level. It 
would be interesting to know the trends of TRF in Ukraine.  
R68-73 Instead the total population numbers it would be much more relevant to know number of 
women in reproductive age as a well as birth rates and abortion rates. Especially last is related to 
contraception use - usually the high use of modern methods and  low abortion rate coincide.  
 
Results  
R 108 -111 Information belongs to "Methods" section.  
R 109 What does mean " eligible  women"?  
R110 Is 83% the response rate?  
R 114 What are „barrier methods" in this study?  
R 115 IUD (in figure 1,2) or IUC (in text)?  
R162 -164 I´m not agree that „proven fertility" is the sign of the most need of effective FP! It can 
be "plans for future pregnancy".  
Table 2 to not provide relevant information and can be replaced showing the numbers in the text 
(R 122 -123).  
Figure 1 IUD with  hormone is known as IUS (intrauterine system) or LNG -IUD (levonorgestrel 
containing IUD).  
Are the methods appropriate and well descr ibed?  
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 supp orted 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  
 
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, writ e 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to t he authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. 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/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as  confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal