Title: Perceived health facility-related barriers and post-abortion care-seeking intention among
women of reproductive age in Osun state, Nigeria
Version: 1 Date: 23 Apr 2023
Reviewer's report:
Perceived health facility-related barriers and post-abortion care-seeking intention among women
of reproductive ages in Osun state, South-West, Nigeria
The study investigates health-related barriers as factors that discourage intentions to seek PAC
in Osun State, Nigeria. The authors analysed data collected from a sample of 1065 sexually
active women across six local government areas in Osun State. I have some comments that the
authors may consider toward improving the manuscript:
Title:
I understand that the authors are trying to communicate the focus of the study right from the
title, but I believe the title can the re-written in a shorter and clearer manner
Abstract:
You reported employment as a predicting factor in your abstract, but the title read “health
facility-related barriers”. This again suggests that you need to reword your title accordingly.
Apparently, you investigated and reported factors beyond “health-related” ones, even though
you mentioned the “principal explanatory variable” in your methods. May I suggest that you use
your word count well at the level of abstract? You have told us that women who were employed
and skilled were 51% more likely…………………. But you also showed the adjusted odds ratio
and confidence interval. You may want to stick to one at the level of abstract. Same for women
who had support from spouses.
Introduction:
“PAC refers to the bundle of care that is offered to women who experienced a problem from
any form of abortion.” This suggests that PAC focuses on those who experience some problems
after abortion. Does it mean that those with no complications do not need PAC? However, the
sentences that follow contradict the statement in quote. So, you may want to reword the statement
or make clarification.
Towards the last sentence of the second paragraph, you told the readers how many abortions
happen in Nigeria annually and claim that Nigeria contributes significant to the 185 deaths
per 100,000 abortions in Africa. But you forgot to mention how much Nigeria specifically
contributes. Of the 185 deaths in Africa, how many happen in Nigeria?
How does Osun State compare to other southern states? The figure is 17.1% in Osun State, but
what about other states. This will make the readers know whether the attention should also be
shifted to some other states in southern Nigeria. Of the 19 states in the south, what is the position
of Osun State? What is the position of Osun State in Nigeria?
Methods:
The measure of the outcome variable is not very clear. You stated that you used two questions:
“(i) ‘should women seek -post-abortion care?’, followed by ‘where should women seek -post-
abortion care?’; and (ii) ‘would you seek -post-abortion care?’, followed by ‘where would you
seek post abortion’”. Does the first question actually measure intention? The first question
appears more like perception/attitude towards PAC. In my own opinion, the two follow-up
questions are saying almost the same thing.
I strongly believe the wording of the second question, which I believe measures PACSI, is
incomplete. In a country like Nigeria where abortion is frowned at and where those who have
done may not openly admit it, it would have been best to ask “would you seek -post-abortion
care, if you committed an abortion for any reason?” The way the authors worded their question
makes me doubt the reliability and validity of the outcome variable.
In addition, the study focuses on women on a very delicate and culturally-sensitive topic. What
is the gender composition of 10 RAs? I am wondering if a woman will respond honestly to your
question on PACSI considering how they are worded.
I advise the authors to re-operationalize their indicators of PACSI. The first question “should
women seek -post-abortion care?” does not measure PACSI intention, in my opinion.