Title: Syrian refugee women’s access to family planning services and modern contraception
during overlapping crises in Bekaa, Lebanon
Version: 2 Date: 05 Jun 2023
Reviewer:  Julie H. Hernandez
Reviewer's report:
Thank you for the opportunity to review this manuscript. The authors are correct in pointing its
value to better understand how supply and demand-side barriers to accessing FP/SRH services
for refugees might have been compounded by the multiple crisis affecting Lebanon in 2019 –
2020. The qualitative methodology provides rich and textured insights into the perspective of
Syrian refugees.
Some additional improvements could however be applied to the manuscript in order to
strengthen its presentation and further leverage the collected data. We organized these suggested
edits by manuscript section below:
Background
We recommend briefly presenting the geographic distribution of Syrian refugees early in the
Background section. The manuscript mentions Beirut several times but then focus on two towns
in the Bekka without clarifying the distance and mobility patterns between these areas.
Could the authors briefly outline the FP services supply situation in Lebanon before the multiple
crisis of 201(1) – 2021? What service delivery points were accessible to refugees in particular?
(e.g. public facilities, private sector, pharmacies, NGOs, community-based services…)
l.145 While the data collection for this manuscript took place in 2020, it might be worth re-
adjusting the language to the current situation (2023), suggest using “Even after the national
lockdown ended…” Other adjustments might be required.
Figure 2 does not have a legend or a scale and does not include the full country or a localization
insert. Readers not familiar with Lebanon cannot situate Beirut in relation to the two study sites,
nor the Bekka area or the Syrian border. We recommend producing an original map rather than
inserting a screenshot of a map created for a different purpose.
Participant recruitment What were the eligibility criteria (exclusion and inclusion) for the FGD
participants? Do the authors have a sense of the refusal patterns?
Analyses were there any efforts by the research team to provide feedback to the participants and
to get them to validate the key findings after the analysis was completed?
The Results section seems underexploited. The authors have obviously collected rich materials
and it would be valuable to present more detailed findings (e.g. l. 6 to 10)
Overall, it seems like Covid-19 was the main crisis “felt” by the refugees. Was the Beirut port
explosion ever mentioned? The refugee location might have been too far from the capital city
for this particular crisis to strongly register ?
L. 413 – 415 repeats concerns over Covid-19 contamination in public transportation (and
consequently increased costs of taking taxis) already mentioned above. Add new details /
materials from transcript or reorganize findings?
Discussion
The reviewer finds Figure 3 an excellent way of summarizing pre-existing or additional barriers.
We suggest placing it in the Results section however, rather than in the Discussion.
l. 515  Injectables are not considered LARC per international family planning guidelines
l.519 – 520 Implants are indeed LARC but the authors should discuss whether the same issue
of “go get it at a private clinic” mentioned for IUDs would not arise as well.
Limitations
Could the authors mention the biases and limitations due to group dynamics occurring in FGD
(which is for example not the case with individual, face-to-face interview).
Additional formatting and English editing
While the manuscript is overall clearly written, we recommend additional English editing to
remove some typos (e.g. l. 525 “for highly mobile refugee women”, l. 543 “an in-person
experience”), review sentence structure and eliminate superfluous spaces (there are double
spaces and font changes throughout the manuscript)