Reviewer’s report
Title: Why do they take the risk? A systematic review of the qualitative literature on informal sector  
abortions in settings where abortion is legal
Version: 0 Date: 10 Oct 2018
Reviewer: Rachel Jones
Reviewer's report:
This study has the potential to make a contribution to the literature but it needs some work before it is  
ready for publication.
First, I think the framework needs to be reconfigured. The authors seem to equate informal sector  
abortions with unsafe abortions, but increasingly that is not the case. Use of misoprostol and even  
mifepristone accessed via the internet mean that many ISAs are safe, or at least not unsafe. The  
introduction devotes too much text to unsafe abortion in highly restricted settings. Instead you should  
provide background information about the (limited) provision of abortion care in countries where many  
folks may not be aware it is legal: Kenya, Ethiopia, South Africa, etc. 
The information on lines 32-40 (page 3) belong in the intro/background and are not part of the methods  
section. 
Why did the authors not include the search terms "self-abortion" "self-induced abortion" or "self-
managed abortion"? Similarly, I was surprised that none of Abigail Aiken's research made the cut. 
What does snowball sampling mean in this context? (line 40, page 6)
Table 2 needs to be revised to include country and sample size/n of interviews, perhaps year of  
publication and journal. Having 8 categories of reasons for 13 studies is too much information for  
readers to process and can be described in the text. Alternately, you could have another tables that lists  
the reasons and the N of studies where it was found to be a motivating factor. 
The US and Hong Kong are "outliers" in this context insofar as they are relatively wealthy and have  
more advanced health care systems. Seeking ISAs in this context has a very different meaning than in  
the other countries and the authors should relate when these two countries are relevant. (Did women in  
the US indicate all 8 reasons or just cost and knowledge?)
The Discussion largely repeats the findings. It would be more useful to synthesize them: ISA occurs in  
less developed and more developed countries, and for a variety of reasons. What are the similarities and  
differences across studies? What are the implications for ISA given that it is increasingly safer do to  
miso and the availability of mife on the internet?  
Similarly, the first paragraph of Conclusions is just repeating the findings and the Discussion and needs  
to be deleted. 
More niggling issues. 
Abstract: last sentence of methods and first sentence of findings are redundant. 
Intro: many of the citations are dated and the authors do not seem aware of more recent research and  
statements. For example, Singh et al. (Lancet Global Health, 2018) estimated that 75% of abortions in  
India were medication abortions performed outside of a health care facility, a lower percentage than  
citation [2]. 
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.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Unable to assess
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  specify  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  publication  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  currently 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 report 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 understand 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