Reviewer's report
Title:Treatments and hazards: A qualitative study of perspectives from women
aged 35 and over on contraceptive methods and use
Version: 1Date:7 September 2010
Reviewer: Tessa Madden
Reviewer's report:
This is an interesting study with an important research question as there is
limited data about women’s contraceptive decision making, especially among
women 35 years or older. Overall, the manuscript is well written and the
qualitative data well presented, however there are some places where greater
clarity is needed, please see comments below.
Please number your comments and divide them into
- Major Compulsory Revisions
Abstract
1. The abstract is not In the results section, the authors list characteristics of
women less motivated to use contraception including “perceptions of decreased
fecundity.” I believe the authors mean that the women thought they were not at
risk for pregnancy, but the meaning here is not clear (i.e. they were concerned
that contraception would lead to decreased fertility).
2. Additionally, the authors say “less opportunity for career and advancement”
however the is no data supporting this finding in the results section, just citation
of another study in the Discussion section. Was this a factor reported in the
women interviewed in the study? If so, please add to the Results section.
Introduction
3. Last paragraph :“We argue…” This sentence seems out of place here. Was
this the original hypothesis? Or the authors’ conclusion from the study in which
case it belongs in the discussion section.
Methods
4. It is unclear from the methods if “inconsistent” vs “consistent” was a planned
category. Was there an a priori plan to recruit a certain number of in each group?
It seems that these definitions are problematic since anyone with an unintended
pregnancy after 35 years would be defined as a inconsistent user even if they
had consistently been using a method for several years.
5. What was the planned sample size?
Results
6. There appear to be inconsistencies with the labeling of inconsistent
contraceptive users and consistent contraceptive users -- N.S. was defined as an
inconsistent user even though she had been taking OCPs for 10 yrs because she
had an unintended pregnancy after 35 yrs. However, F.H. also had an unplanned
pregnancy after 35 yrs but is defined as a consistent user (using condoms).
- Minor Essential Revisions
Results:
1. Paragraph 10: S.C. says that the U.S. progesterone pills have to be taken
within an hour window rather than within the 2-3 hour window allowed by the U.K.
pills. This statement in inaccurate and it is not clear why the authors included it
unless it is to show an misinformation is common, however this should be
clarified in the text.
- Discretionary Revisions
Methods:
1. Please expand on the reasoning behind defining SES using occupation? This
classification has limitations because it does not take into account financial
contributions of a partner, i.e. a woman could work in retail but have a partner
who has an “advantaged” occupation. Of the women who were classified as
disadvantaged, it would be helpful to know how many were employed outside the
home (this is alluded to in the Discussion section). Was there any other
measurement of SES – income, government assistance, etc…?
Results
2. Second paragraph: “women’s perceptions…complex and varied.” Please use
specific examples to explain how the perceptions were complex and varied. The
examples that follow describe “consistent users” and do not appear complex or
contradictory.
3. Paragraph 17: “Factors influencing more consistent…” I am concerned that the
comment “Disliking the responsibilities of motherhood” carries a negative
connotation and does not accurately capture the conflict that R.Z. described
about motherhood. Same for the term “lifestyle.”
4. Was there any discussion of efficacy in the factors that made contraceptives
“favorable?” It is interesting that it is not listed as advantage by disadvantaged
users in Table 2
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
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