Reviewer ’s report  
 
Title: Can community health workers play a greater  role in increasing access to medical abortion 
services? a qualitative study  
 
Version: 0 Date: 24 Sep 2016  
 
Reviewer: Di Cooper  
 
Reviewer's report:  
 
This is a  very interesting and well written article article. It contributes new knowledge to this 
important field.  
 
Abstract:  
Good and clear  
 
Background  
Can the authors expand a bit on the criteria, knowledge by health care workers including CHWs 
and women on early medical abortion and to what extent it is provided in health centres.  
 
Results  
Good and clear.  
If to include caste in table - if relevant to  the findings - then explain what these categories mean 
to the international reader  
Is there any data from the study on what the broader attitude of CHWs/ASHAs were to women 
having abortions as this would seem to be important in their ability to carry out  their tasks and 
women's willingness to use them. See views of women on this - would need also to be sterilised 
for e..g. ; Issue of keeping confidentiality; for rural women, issue of CHW skills - probed more 
about what they knew about medical abortion and  what skills they felt a provider needed to 
have?  
 
 
Discussion  
Good and clear.  
Perhaps link with issues raised with respect to possible recommendations.  
 
Conclusion  
Is there or could there be values clarification and not only skills training for CHWs/AS HAs to 
ensure attitudes are more open to women's needs for e.g. not to so strongly promote sterilisation.  
Issue of lack of confidence compared to doctors:  how could this be dealt with - What do they 
tell clients? Could there be better cooperation with he alth facilities? Could there be more 
established mechanism for having clients let them know how abortion went so can refer if 
necessary?  
There seems to also be important role for ASHAs post -medical abortion to ensure that has been 
successful. For e.g seri es of questions posed to women in a study in S.A using mobile technology 
showed that this was a good idea (Constant D, de Tolly K, Harries J, Myer L. Mobile phone 
messages to provide support to women during the home phase of medical abortion in South 
Afric a: a randomised controlled trial. 2014 Contraception DOI: doi: 
10.1016/j.contraception.2014.04.009). Could this be elaborated on a bit.  
Recommendations in conclusion could also propose some greater information and knowledge 
being imparted to women on medi cal abortion.  
The authors should include that participants could benefit from both contraception and safer 
conception information and strategies depending on their fertility desires. This relates to my 
earlier point about fertility intentions or desires.  
 
Typos  
Line 66, page 4  : ASHAs have been provided with urine pregnancy test kits  
Line 154, page 10: Six were educated upto or above tenth standard. Separate up to into 2 words.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported 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 speci fy 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:  
 
Acceptable  
 
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 publi cation 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 curr ently 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, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that 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 the authors and, if the manuscript is accepted for publication, my named repo rt 
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 understan d 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