Title: Time to initiation of modern contraceptive method use after childbirth and its predictors
in Southern Ethiopia: a retrospective follow-up study
Version: 3 Date: 06 Jul 2023
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: This is a retrospective study examining the length of time from
childbirth to initiation of contraception practiced by Ethiopian women.  The retrospective nature
of the data collection detracts somewhat from the study’s usefulness.  With this caveat in mind
the study was generally well performed and analyzed.  The results are in general presented well,
although the data regarding time to contraception initiation could be better presented in graphic
form.
The results are similar if not identical to several studies in Ethiopia as well as other LMI
Countries.  Unfortunately, the paper in its present form does not compare and contrast the present
results with other studies, and hence it is unclear how the paper adds to knowledge regarding
this important issue.
ADDITIONAL REQUESTS/SUGGESTIONS:
P3, line 46-47- “World Health Organization recommendation of at least 6 weeks”   I believe
you mean at most 6 weeks.
Line 74 – it appears you are citing 2 studies; change to “According to the studies”
Line 103 - The participants were selected from women bringing 1 year old children to a vaccine
clinic. This is likely to bias selection against to women and families who do not utilize health
facilities.  This should be discussed as a limitation.  It might also eliminate women who have
become pregnant before the child’s 1 year birthdate.
Line 107-112 – This section is unclear.  What is the difference between “The dependent variable
was the time to initiation of modern contraceptive use in completed months”  and “The duration
of months spent from childbirth to subsequent initiation of modern contraceptive use, was a
time variable”?
Line 109 - Please explain why the “event” was defined as women choosing to initiate
contraception within 6 months postpartum.
Line 204 - mean age of the study
Line 208-209  Please provide a graph depicting the distribution of the time of contraception
initiation.  A Box and whisker plot would be preferable for this graph.
Line 265 – “the rate of mistimed pregnancies is becoming a big problem”  This implies the
problem is worsening.  Is this true (if so cite a reference) or has it always been true?
Line 267-69 - The authors cite 2 previous studies performed in Ethiopia which had similar results
to the present study.  Please explain how the present study advances knowledge beyond what
was previously shown in these studies.