Title: Clients’ expectations and experiences with providers of menstrual regulation: A
qualitative study in Bangladesh
Version: 1 Date: 20 Nov 2023
Reviewer's report:
The paper is well-written, but the logic is sometimes stretched. The particularity of their sample
to have more than half be surgical abortions is not reflective of the population of Bangladesh; the
authors should consider highlighting that peculiarity to make sure that readers understand this--
especially in a limitations section (there currently is not one). Because they had no unmarried
women in their sample, they should specify that the results are only applicable to married women.
The category of Call Center is confusing because that is not where the women got the abortion—
can the authors separate recruitment site from where the abortion occurred and identify quotes
by where the abortion occurred, and not the recruitment site? I am left at the end of the article
not understanding the experiences of women who bought MA directly from a pharmacy. Is it
possible to specify that all surgical abortion was MVA or was some of it perhaps D&E?
Line 69: Not sure that lack of knowledge about “MR” = challenges with access. (Line 75-76—
what’s the evidence of that? You need a data point that shows that women who don’t know of
MR don’t access it otherwise, pull back from making such a strong statement.) What happens
when a woman walks into a facility and requests an abortion or “a wash”? The DHS has not
been consistent in the way it’s asked the question during that timeframe and so the reduction
in the percent of women saying they know MR may be more an artifact of that than of a true
change in knowledge.
The authors should include more of a description of what the call center is—is it also an
accompaniment model of abortion support? What else are they doing?
Line 151: Word missing: “Written informed CONSENT”
How was written informed consent given when the interviews were done over the telephone?
Why did such a large proportion of the sample receive surgical abortion? That doesn’t
reflect the experience of the majority of women getting MR in Bangladesh and it makes the
results particular to women having surgical abortions, which is a specific subset of women in
Bangladesh.
Unanswered questions that if answered would enrich the analysis/deepen our understanding of
women’s behavior:
• Were women given a choice of method when they went to a facility?
• Was women’s concerns about dirty instruments and uterine scarring a reason women chose
MA?
• Did expectations of provider interactions drive women’s choice of provider/location of care?
• Lines 239-243: Did clients feel well informed after speaking to someone from the call center
or before? Is this a comment on the services being provided by the call center? How many who
contacted the call center had also been in a maternity hospital or NGO clinic? It feels a bit
circular/self-evident that women seeking out additional support get additional support…
• Line 250: Can the authors provide specific information about what they are deeming
“problematic framing”?
• What about consent for the procedure/consent from others?
Smaller observations:
Line 272: “baby” should be in double quotation marks.
Line 275-277: Double quotation marks outside and single quotation marks inside the quote (as
the authors do in indented quotes).
Line 297: Quote should have double and single quotation marks around it.
Lines 373-375: Low levels of knowledge are different than misinformation in this situation.
Line 234: Where is “there”?
Line 305: “service” should be plural. “too close together” should be in quotes or otherwise
indicated that this is the provider’s perception.
Lines 312-313, 317-318, 344-345: Again, should be double quotation marks
Line 362: “rest” should be singular.
Line 398: “reception” should be capitalized; “triage” should be capitalized.