Title: Women’s sexual empowerment and utilization of long-acting reversible contraceptives
in Ghana: Evidence from the 2014 Demographic and Health Survey
Version: 1 Date: 17 Apr 2023
Reviewer:  Nawaf Saeed
Reviewer's report:
Overall, this is a well-written paper on a critical and understudied topic: Women’s sexual
empowerment and utilization of long-acting reversible contraceptives in Ghana: Evidence from
the 2014 Demographic and Health Survey. I commend the authors for using a large amount
of rich, multi-level data. However, the paper still needs improvement in terms of grammar
statistical analysis.
Abstract
Line 26, the author stated that, the main objective of this study was to examine the association
between women’s sexual empowerment and LARC utilization in Ghana. However, the author
presented findings on factors like educational status, religion and their association with
utilization of LARC. If such results should be maintained, I suggest the author either change
the topic to “Determinants of the utilization of long-acting reversible contraceptives in Ghana:
Evidence from the 2014 Demographic and Health Survey”
Introduction
The introduction should provide reasoning for including each of the variables in the logistic
model, including the covariates. It’s not sufficient just to say they were selected a priori based
on the literature, without explaining what the hypotheses were.
The authors fail to state the hypothesis of the study
Methods
Line 120, the author stated the covariates that were controlled for in the analysis. However, the
author failed to explain how each covariate was adjusted for. Two models were used in this
analysis. Thus, it should be stated clearly, which of the covariates were controlled for in each
model.
Line135 :- As this is a cross-sectional analysis, authors cannot use the phrase “impact” in the
manuscript. Instead, they can say “is related to” or “is associated with” or “correlates
Line 99 Report the cut-off used to dichotomize “Long-Acting Reversible Contraceptive into 2
categories.
Authors should explain how wealth index computed and basis for classification
Results
The tables presented by the author in the results section are inconsistent.
The chi-square results presented for Sexual Empowerment, it’s most likely that some of the cells
would have an expected count less than 5. Could authors confirm this and explain how they
address that.
Line 186 Authors have incorrectly described the meaning of an odds ratio, by saying that women
are “more likely” when they should instead refer to the odds, saying “higher odds of reporting”
or “the odds of using LARC higher”
As I note throughout this review, authors should explain what the covariates were how they
controlled in the various models.
Line 182 and 183, the authors claim “both the unadjusted and adjusted models show that the
utilisation of LARC decreases with an increase in women’s sexual empowerment” yet they fail
to indicate that the confidence interval was not statistically significant. In fact, this was the main
aim of the study, nevertheless, the authors failed to provide details of that, unlike the covariates.
Discussion
Line 209 authors stated that “both the unadjusted and adjusted models show that the utilisation
of LARC decreases with an increase in women’s sexual empowerment” but did not indicate that
it was not statistically significant.
Line 210 “A possible explanation is that these women, although sexually empowered may fear
side effects and therefore opt against the use of LARC” authors attributed
Line 220, the authors explained the odds of using LARC reducing with an increase in age to
be attributed to the fact that younger women might still be in school and do not intend to birth
children which is likely to interrupt or truncate their education. This is no longer the case in
Ghana, as women are allowed to school while they give birth.
Line 223 While authors try explain the reason why older women were less likely to use LARC,
they brought in educational status which does not really link with age. Perhaps the authors
implied the experience of the older women and not their education.
Conclusion
The authors failed to state the association between long-acting reversible contraceptive
utilisation and women’s sexual empowerment.