PONE-D-19-22660

Community perception towards abortion, women who abort and abortifacients in Kisumu and Nairobi Counties, Kenya

PLOS ONE

Dear Mr Juma,

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PLOS ONE

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #2: N/A

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: The manuscript is original using cross-sectional exploratory study combining focus group discussions and in-depth interviews that explored community perceptions and beliefs relating to abortion, its users and abortifacients in Kenya. Both gender and healthcare providers (adult men and women, pharmacists, nurses, and community health volunteers) had participated in the study. The author noted that women who are seeking abortion are traumatized and excluded from society due to personal, religious, and social stigma.

The langage of the manuscript is correct and clear but we noted some specifics errors. The Introduction is lenghty, no need to provide a lot of information, revise it. Methods: The authors need to be more analytical, to provide statistical analysis by using weighting in the responses in order to make a hierachisation of the items. For a better understanding, use tables in the main Results. Be more precise in the Conclusion.

In the References, we note more specifics errors :

Reference 1: complete the pages number 130- ?

Reference 10: compléter the source

Reference 17: complete the pages numbers185- ?

Reference 24: re-format the title which is en capital

Reference 30 : provide journal name

Reference 33 : provide journal name

Reference 34: verify the page number there maybe too many figures

Reference 36: re-format the title which is in capital

Reference 37: complete this reference

This paper can be accepted once these modifications are made.

Reviewer #2: The work presented provides a strong case regarding the importance of addressing health policies regarding the provision of safe abortion services and post-abortion care from a multilevel perspective, from the necessary legislation, provider orientations, stock assurance and points of distribution, up to local interventions.

First, it contributes to the existing literature that links the religious and cultural values ​​that build the stigma of abortion in the persistence of unsafe abortions in contexts where it is legally permitted. Secondly, and in our opinion its greatest contribution, makes visible the different barriers that women face to perform an abortion, which are of a material nature –lack of stock and distribution positions of the drug, as well as its high cost when operating criteria supply-demand–, but also socio-cultural –stigmatization, lack and/or inaccuracy of information on medical abortion, the complexity of the pharmaceutical-client relationship. The latter are key to the design of community interventions that reduce the gaps in access to safe abortion for women.

One of the innovative aspects of the study surveyed by the authors is the inclusion of men in the sample, in this sense, it would be interesting to discuss gender differences in perceptions regarding abortion. Although the results indicate the differences regarding the perception of abortion observed in rural and urban contexts, and at the gender and generation level (young non-urban women would be more open to understand abortion as a legitimate personal decision), it would be interesting to understand how this differentiation could be approached to positively impact the design of community interventions.

Finally, a revision of the text is recommended since some minor errors were found (eg discrepancy between the characterization of the appointment "married women" and the description thereof in the preceding paragraph "married men").

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Reviewer #1: No

Reviewer #2: Yes: Claudia Moreno Standen

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Community perception of abortion, women who abort and abortifacients in Kisumu and Nairobi Counties, Kenya

PONE-D-19-22660R1

Dear Dr. Juma,

We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements.

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With kind regards,

Denis Bourgeois

Academic Editor

PLOS ONE

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