Title: Women’s experiences of living with involuntary childlessness in Uganda: A qualitative
phenomenological study
Version: 3 Date: 23 May 2022
Reviewer:  Ghada Al-attar
Reviewer's report:
*The paper topic is interesting and supports in addition, adds to the literature not only in Uganda
but to similar cultures in other countries.
*The author paid an appreciated effort in the result section, however, here are some comments
which I believe would enrich the paper:
**In the methodology section:
*line 107 & 108, the authors mentioned that the study was conducted at Kawempe National
Referral hospital. Please add more details about justification of selection of this hospital. Is it
the largest hospital in the area? The only hospital that offers OBGYN services?
*line 117, the authors mentioned that 15 participants were interviewed (out of 18 were
approached in another section), however, data doesn’t provide information on residence of the
study participants. Urban/rural residence would affect the mental health through the frequency
of exposure and burden of social pressures which may differ by residence.
*Line 139, which software was used to identify the main themes and codes?
**In the results section:
*Results do not give an idea about the reasons of involuntary childlessness and whether the
cause is partly related to the husband and his wife or it is only the wife though all women were
recruited from the hospital! In addition, the authors mentioned in couple of places in the result
section, the financial barriers that some women experienced.
Adding this information about the main cause (if possible) could have better explained the
women experiences especially  for the themes related to social support and financial constraints.
*Moreover, in table 1, the authors included women with very wide range in duration of
involuntary childlessness. This difference could have been explained in the results with more
details as the experiences and coping mechanisms of women would have been affected by the
duration of suffering.
*Line 155 as well as in table 2, social support
One of the main categories that could have been included within the social support theme is
women autonomy and decision making. This category resonates with fertility patterns mentioned
in the DHS though comparison between different methodologies is not applicable.
*Line 400, and in table 3, I would change the theme self-belief to optimism or trust in future.
*Line 418, as for the family & social support theme in the coping mechanisms. Actually, I
believe that this contradicts the impacts of involuntary childlessness and experiences of women
who suffered from inadequate social support mentioned in previous sections!
**In the discussion section:
*Further analysis in the discussion to differentiate between women who had social support and
those who didn't would have enriched the study with more insight.
Moreover, the authors gathered information about the educational status and occupation of the
participants, however, no insights were explained in the discussion about whether women with
lower education and working were getting less social support or suffer more negative coping
strategies than those who had higher education.
In line 495, How many women were socially unsupported by their families compared to those
reported receiving social support?!
*Lines 542 to 544, the authors mentioned this paragraph as a fact while the in-depth interviews
were carried out with women only. These are just women's opinions, perceptions and thoughts!
I suggest the language to be changed to as perceived, some women reported that their husbands
searched for relationships within or outside the context of marriage … etc.
*Line 555, the word some is not accurate. Please be more precise as based on the current results,
only one participant was divorced while no separation was reported!!
**The conclusion section (line 640 and beyond)
The conclusion section is very long and it is almost repetition of ALL the results in details!!
Please rewrite the conclusion and summarize it into couple of sentences and add the policy
implications of your findings.