Reviewer ’s report  
 
Title: What Contraception Do Women Use After Experienci ng Complications From Abortion? 
An Analysis of Cohort Records of 18,688 Postabortion Care Clients in Tanzania  
 
Version: 1 Date: 04 Jan 2018  
 
Reviewer: Beverley Lawton  
 
Reviewer's report:  
 
Thank -you for the opportunity of reviewing this interesting paper. This paper is a  good example 
of conne cting silos  and giving effective integrated care for women .  
 
 
Please clarify in the introduction whether this is concerning women who have had a spontaneous 
abortion with retained products perhaps   or those who have had a induced termination of 
pregnancy ( unintended pregnancy or due to foetal abnormailty) and then they have 
complications and attend for PAC. If the abortion is induced then where is it done.  What is the 
legality in Tanzania as regards induced abortions and choices for contraception. Its no t clear . I 
wondered if the PAC was a euphemism for abortion clinics. With abortion providers there is an 
expectaion that adequate contraception is provided.   
 
 
These clarifications should be thru out the paper. As it reads it basically says these women are  
presenting with complications  post abortion - not where or whether it was induced - unsafe or 
otherwise .It would be good to get a grasp on how big this issue is in Tanzania - how many 
unplanned pregnancies are there that may have abortions and compared to ongoing pregnancies. 
What is the death rate of women post abortion.  
 
 
 
Background  
 
Suggest second sentence be split up and referenced as its a bit confusing  Is the life saving 
treatment the PAC package.Is more detail needed for the holistic programming mo del as pertains 
to Tanzania  
 
 
Page 5 para 2 line 40 - somewhere it would be good to have a local picture - where abortions are 
done - are they legal etc and how does Tanzania fit into examples given above.  
 
 
 
 
 
Discussion  
 
The message around decentralization and training allied health professionals to improve access 
to services for women is a good one.  
 
Of interest what was the contribution of local researchers to this paper - I see that it appears  that 
both the first and senior authors are not local from Tanzania ? 
 
Do you have any data re women having repeat pregnancies over time post their PAC?  
 
Figure 1 - don't use acronyms - be good to expand what they all are - what did emergency 
treatment consist off.  I have not got a clear impression of the methodology behind the 
community empoerment bit  
 
 Fig 5 probably could be in the text.  
 
Figure 2 reflects that the clinics are gradually being recruited to the new service. Is that correct.?  
Do we have any idea of presentation to the clinics before they started with PAC services - 
numbers and whether they received care or was it all central at this stage.  
 
Figures would benefit from titles being more explicit  
 
For example Fig 4 should have contraceptive method in title. Was there a zero percent for natural 
method - I would leave it out then - we could debate whether that is a modern method.  
 
Figure 3 . Title and the colour coding not consistent - suggest you define in text modern FP 
method and use no method for other. This has no method in title but without a modern method as 
a descriptor  
 
Finally - the title is a good one but perhaps after answe ring questions re the inclusion criteria of 
group it may change - Contraceptive choices post abortion complications in Tanzania . But this 
paper is more than that it also includes the training of health professionals and dexentralisation of 
services. Is th ere anyway this can be linked to a reduction in maternal mortality which is feasible 
with adequate emergency treatment and contraception  
 
 
 
 
 
 
 
 
 
 
 
 
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.  
 
Yes 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specif y 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:  
 
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3. Do you hold or are you currently applying for any patents  relating to the content of the 
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