Reviewer's report
Title:Voluntary family planning in association with the paradoxical situation of
high use of contraceptives and abortion in Viet Nam: a cross-sectional study
Version: 1Date:23 January 2012
Reviewer: William Stones
Reviewer's report:
Review of:
Voluntary family planning in association with the paradoxical situation of high use
of contraceptives and abortion in Viet Nam: a cross-sectional study Phuong Hong
Nguyen, Meiwita P Budiharsana
This study draws on findings from a formally designed population survey of
married women in a province of Vietnam and uses statistical tools to examine
hypothesised relationships between abortion behaviour and engagement with
family planning messages and services. The importance of the topic is
established by the authors, ie the national context of very high abortion rates
despite substantial investment in family planning services. At a time when many
countries are attempting to revive stalled family planning efforts, the findings will
be of interest to readers in other regions especially in sub-Saharan Africa. One of
the policy arguments used by family planning advocates is that effective FP
services will reduce the need for abortion, especially unsafe abortion which
generates a massive burden of maternal morbidity and mortality. The study
design is appropriate to address the questions raised. The authors could
comment more specifically on the extent to which they regard the findings as
statistically generalisable to the providence and national level, or the limits they
consider to apply: the sampling design would indicate that the findings should be
generalisable, unless the authors consider this particular province to be very
different from the national context in some way (eg ethnic make up- although
they show a lack of influence of ethnicity in their models). For the discussion, the
authors could amplify the policy implications mentioned above. Specifically,
they hint at possible explanations for the poor performance of the FP programme
dimensions such as a disconnection from remuneration or career progression of
health workers, which may mean that workers do not take this programme
seriously in their contacts with clients. However, the authors do not touch on the
social dimensions of fertility, family planning and abortion
at community level. The reader would like to know more about the attitudes of the
people: is it that most are content with the status quo of high rates of induced
abortion, or is there unmet need and demand for family planning that the vertical
programme is failing to meet? To the reader it appears that the programme may
be excessively centrally driven (perhaps by donors?) and that communities
have perhaps not been fully drawn in to policy and programme making- hence a
lack of impact at population level. Or is it that the programme is well designed
and could meet community expectations, but is being held back by organisational
limitations. There may be existing literature from Viet Nam that the authors can
draw on to provide these explanations: if not, this would appear to be the
research agenda that requires attention and this could be set out by the authors.
Recommendation: the article has merit and should be published. It would be
strengthened by expansion of the policy and programming implications as
discussed above