Title: Recent trend and correlates of induced abortion in China: Evidence from the 2017 China
Fertility Survey
Version: 3 Date: 30 Jun 2022
Reviewer:  Monica Malta
Reviewer's report:
The authors successfully addressed several of my comments and critiques.
However, I still have a few concerns that need to be addressed before publication. This month
(June, 2022) the  U.S. Supreme Court officially reversed Roe v. Wade on Friday, declaring that
the constitutional right to abortion, upheld for nearly a half century, no longer exists. This is a
highly sensitive and important theme and I think that one must be very careful when discussing
reproductive justice, including women's  right to  access safe, legal abortion.
1. Introduction, 1st paragraph: "on the flipside, induced abortions are detrimental to women’s
reproductive health and fertility.7 "
This notion is not accurate and the reference utilized here does NOT corroborate this idea. The
paper published by Jing Fang et all (Achieving SDG related sexual and reproductive health
targets in China: what are appropriate indicators and how we interpret them?) clearly states that
" Safe abortion is a key dimension of sexual and reproductive rights.", a notion corroborated
by the World Health Organization, UN Women, CDC and all international organizations. Safe
induced abortions are NOT detrimental to women’s reproductive health and fertility. UNSAFE
abortions, on the other hand, can indeed be detrimental to women's reproductive health and
fertility.
According to the authors, unsafe abortion is very rare in China. Therefore, I would like to request
the authors to revise this sentence accordingly (probably deleting it). In a worldwide scenario
where women are loosing the right to chose when, how and if they want to become pregnant,
those sentences are highly dangerous. I would also like to reinforce the need for a very carefully
written manuscript, to be published on a leading journal, BMC Women's Health. BMC WH
scope states that the journal "considers articles on all aspects of the health and wellbeing of
adolescent girls and women" - a sentence mentioning that safe, induced abortion is detrimental
to 'women’s reproductive health and fertility' is completely out of place in the scientific arena.
Following on the same paragraph, the authors mention that "As part of the SDG-related sexual
and reproductive health targets, it is necessary to avoid unintended pregnancies to reduce
induced abortions.", citing once again the manuscript published by Jing Fang et all. However,
a key discussion presented by Dr. Fang was committed here, the need to increase access
to sex education and improve ensure "universal access to quality reproductive healthcare by
all reproductive age women, regardless of their marriage status". Once again, the manuscript
resubmitted by Dr Tian Wang and Dr Quanbao Jiang seem to be dangerously influenced
by outdated viewpoints that jeopardize a broad evaluation of gaps in women's sexual and
reproductive rights and care in China. Please review.
Through all introduction, please clarify  if the statements are solely related to China, or if the
authors are discussing a worldwide trend. If all the introduction focus solely on China, please
state so to avoid confusion.
For instance:
"Married women and women with children are more likely to undergo repeat induced abortions"
- is this the reality in China? Worldwide, it is not clear whether married or unmarried women
are more likely to undergo induced abortions, as per data from WHO and UN Women
The Chinese Context, Premarital pregnancy: please define OECD.
Methods, data: "We excluded observations over 60 years old, those whose marriage/cohabitation
information was missing, and those whose age at first marriage or first pregnancy was less than
15. "
Please briefly include here the percent of your data that was excluded for each of those eligible
characteristics. What percentage of observations was excluded due to missing data on marriage/
cohabition? What percentage of data was excluded due to age 15 or lower? And is it legal in
China for adolescents aged 15 or less to get married?
Methods: "Then, we regressed induced abortion experience on associated factors." please review
this sentence, it could be better written as "we conducted a binomial logistic regression analysis
on whether or not xyz"
Results: BRAVO! Thanks for conducting this additional regression analysis, it makes your
manuscript more robust and very interesting.
Conclusion and Discussion, 2nd paragraph: " Induced abortion played an important “remedial”
role for out-of-plan pregnancy in the implementation of birth control policy." I don't understand
this sentence... Are you implying that the uneven access to reliable contraception might
influenced unintended pregnancies and, as a result, abortion? Please clarify.
Overall your manuscript improved a lot, and the remaining questions require just an extra effort
from the authors. Thanks for the opportunity to review this highly important study.