Title: Health care provider reporting practices related to self-managed abortion
Version: 1 Date: 07 Dec 2022
Reviewer:  Jennifer Innis
Reviewer's report:
Overall, this is an interesting paper to read about a timely issue in the United States.
It is not clear from reading this paper if providers are legally required to report self-managed
abortion (similar to the legal requirement to report child abuse). There is reference made to the
recommendations of the U.S, Health and Human Services Office of Civil Rights with respect
to privacy legislation (actually, this point is made twice on pages 4 and 15). However, it is not
clear if reporting requirements are decided at the federal level or the state level. Do states require
this? If so, which ones? In addition, it would be helpful to know if participants were located in
states where this is required (if it is in fact required).
The background refers to “self-sourced” SMA methods. Later we find out that patients can
obtain medications from online pharmacies or from another country. Is it possible to add this
information earlier, as it is not clear what self-sourced means until later in the paper?
There are references to American legal cases that may not be familiar to readers outside of the
United States (including this reader). For example, on page 14 there is a reference to the pre-
Dobbs era. What does this mean?
There are repeated references to government agencies. This reference is unclear. Do the authors
means child protective services and the police? Are there other government agencies that would
be involved?
On page 5, it states that study results have been described in detail elsewhere. There are details
provided of the study methods (although details are missing). The reader should not have to
consult another publication to find out the study methods. Could the missing details be added?
(See below for missing details)
Physicians were purposively sampled. How were they purposively sampled? How did
recruitment take place. In addition, the participants included advanced practice nurses. How
were these participants recruited?
The analysis is described as first taking place using deductive analysis with a framework, and
then switching to inductive analysis. The themes presented in the results section are directly
from the research questions, making the analysis appear deductive. Were there not themes that
arose from the inductive analysis?
Page 7 (near the bottom) refers to adjacent practices. There are quotes around adjacent, and it is
not clear what this means. It is later described on page 10, but this could be defined on page 7.
On page 8, the first sentence directly under Table 1 is unclear and hard to understand.
The top of page 12 seems to refer to patients engaging in domestic violence. As pregnant persons
are more likely to be the victims of domestic violence, suggest rewording this.
The quote at the top of page 13 is difficult to understand. Is there a way to make this clearer,
or make the point of the quote clearer.
On page 14 the authors note a participant took “pride” in a report. The rationale for this is not
strong (and unclear).
Overall, the results section is interesting to read. However, the discussion section and the
conclusion do not give the reader a strong sense of what is new about these findings, or what the
implications of the findings are. The take away seems to be that provider who have patients that
have attempted self managed abortion might report them. It seems we already have a sense that
this is the case from the background. This is such an interesting study - is it possible to highlight
what is new about the findings from this study, and what the implications might be?