Understanding the association between parental attitudes and the practice of female genital mutilation among daughters

Claudia Cappa; Claire Thomson; Colleen Murray

doi:10.1371/journal.pone.0233344

Peer Review History

Original SubmissionDecember 19, 2019
4 Feb 2020 Decision Letter - Kimmo Eriksson, Editor PONE-D-19-35066 Understanding the association between parental attitudes and the practice of female genital mutilation among daughters PLOS ONE Dear Dr. Cappa, Thank you for submitting your manuscript to PLOS ONE. It took some time for me to secure two reviews from qualified reviewers. Both reviewers think that your piece is interesting and should be publishable after some revisions. R1 recommends a more thorough literature review. I suggest you have a look at a PLOS ONE paper I edited last year, https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0213380 R1 also gives suggestions how to improve the discussion section. R2 's comments focus on the analysis and the presentation of results. I generally agree with both reviewers and invite you to submit a revised version of the manuscript that addresses the points raised during the review process. We would appreciate receiving your revised manuscript by Mar 20 2020 11:59PM. When you are ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. To enhance the reproducibility of your results, we recommend that if applicable you deposit your laboratory protocols in protocols.io, where a protocol can be assigned its own identifier (DOI) such that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). This letter should be uploaded as separate file and labeled 'Response to Reviewers'. 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The PLOS ONE style templates can be found at http://www.plosone.org/attachments/PLOSOne_formatting_sample_main_body.pdf and http://www.plosone.org/attachments/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Please consider revising your Abstract and make sure it it structured in terms of clearly defined background, objective, methods, result, conclusions. Refer to our submission guidelines for further guidance (https://journals.plos.org/plosone/s/submission-guidelines#loc-abstract). In addition, please refrain from stating p values as 0.000, either report the exact value or use the format p<0.0001. 3. PLOS requires an ORCID iD for the corresponding author in Editorial Manager on papers submitted after December 6th, 2016. Please ensure that you have an ORCID iD and that it is validated in Editorial Manager. To do this, go to ‘Update my Information’ (in the upper left-hand corner of the main menu), and click on the Fetch/Validate link next to the ORCID field. This will take you to the ORCID site and allow you to create a new iD or authenticate a pre-existing iD in Editorial Manager. Please see the following video for instructions on linking an ORCID iD to your Editorial Manager account: https://www.youtube.com/watch?v=_xcclfuvtxQ 4. Please amend your manuscript to include your abstract after the title page. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: This is an interesting and valuable paper on analysis of DHS data from multiple countries on parental attitudes toward and support for FGM. While the analysis is sound, I found that both the introduction to the paper and the (lack of) discussion at the end limit its value to the field. Overall, I felt that the authors needed to provide a more detailed summary of recent published research on FGM, of which there is a considerable quantity including from the countries of interest in this study and including evidence of effective intervention strategies. Also, there is no discussion section. The authors state conclusions, but these are really just a restatement of the results section. There is no interpretation of findings, discussion of potential future research, or detail on future interventions or approaches that might be implied by this research. More detail needs to be provided on why this study matters to the field. The analysis is sound, but it's not clear why we should care. What does this study really tell us, and where does it suggest we should go from here? Reviewer #2: This article analyses the relationship between FGM and parental attitudes towards FGM in African countries where FGM is more or less common. The most interesting, if somewhat depressing, result is that mother's attitude trumps fathers attitude when they disagree. I find the paper convincing, well thought through and well written, though with substantial shortcomings that need to be addressed before I can recommend an accept. 1. Type of FGM is not included in the analyses. This could make a huge difference as some earlier studies have revealed a higher commitment to more costly rituals. Conversely, it may be easier to maintain a less costly commitment. Either way, type of FGM should be included in the analyses. 2. These results can be much more transparently presented in graph format. It is unnecessarily difficult to go through all results in table form. Please rectify this. 3. Where are the results from the statistical tests? It is stated in the text that there should be tests included, but these results are nowhere to be found. Thus, I don't really know if the results are what the authors say they are or not. These shortcomings are of a magnitude that I cannot recommend acceptance, unless a major review is carried out. But the results seem interesting, if they are as presented, so please go through the work to do this. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files to be viewed.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0233344.r001
Revision 1
19 Mar 2020 Author Response Reviewer #1 This is an interesting and valuable paper on analysis of DHS data from multiple countries on parental attitudes toward and support for FGM. While the analysis is sound, I found that both the introduction to the paper and the (lack of) discussion at the end limit its value to the field. Overall, I felt that the authors needed to provide a more detailed summary of recent published research on FGM, of which there is a considerable quantity including from the countries of interest in this study and including evidence of effective intervention strategies. The section with the literature review has been revised significantly to add more detailed summary of recently published research on FGM. Also, there is no discussion section. The authors state conclusions, but these are really just a restatement of the results section. There is no interpretation of findings, discussion of potential future research, or detail on future interventions or approaches that might be implied by this research. More detail needs to be provided on why this study matters to the field. The analysis is sound, but it's not clear why we should care. What does this study really tell us, and where does it suggest we should go from here? A discussion section was added. Reviewer #2 This article analyses the relationship between FGM and parental attitudes towards FGM in African countries where FGM is more or less common. The most interesting, if somewhat depressing, result is that mother's attitude trumps fathers attitude when they disagree. I find the paper convincing, well thought through and well written, though with substantial shortcomings that need to be addressed before I can recommend an accept. 1. Type of FGM is not included in the analyses. This could make a huge difference as some earlier studies have revealed a higher commitment to more costly rituals. Conversely, it may be easier to maintain a less costly commitment. Either way, type of FGM should be included in the analyses. We did look at data on the circumstances surrounding the practice, including girl’s age at cutting, practitioner and type of cutting. The original intent was to see whether such circumstances would show differentials by parental attitudes. The hypothesis there was that, for instance, among couples with discordant opinions, the cutting may still happen but in milder forms or at younger age or with the involvement of a health professional as opposed to a traditional circumciser. We later decided not to show the results in the paper for a number of reasons. Circumstances do not seem to change drastically by parental attitudes. Most daughters underwent FGM when they were 0 to 4 years old and in none of the countries did age at cutting significantly change by parents’ opinions. The majority of girls were cut by traditional practitioners regardless of parental opinions towards the practice. Finally, there was a certain level of variations across the countries in terms of types of FGM covered in the surveys. The only category that was constant was infibulation, which was rare in the countries with data. Finally, due to the low number of cut daughters in some countries, the analyses on age, practitioner and type of FGM by parental attitudes had a very large level of uncertainly and many values had to be suppressed, which made the results less reliable, and therefore not that meaningful. 2. These results can be much more transparently presented in graph format. It is unnecessarily difficult to go through all results in table form. Please rectify this. Two graphs were added to illustrate the findings in tables 2 and 3. 3. Where are the results from the statistical tests? It is stated in the text that there should be tests included, but these results are nowhere to be found. Thus, I don't really know if the results are what the authors say they are or not. The statement in the article was rectified to reflect only the actual type of analyses that were performed. Additional requirements: When submitting your revision, we need you to address these additional requirements: 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at http://www.plosone.org/attachments/PLOSOne_formatting_sample_main_body.pdf and http://www.plosone.org/attachments/PLOSOne_formatting_sample_title_authors_affiliations.pdf Style requirements were reviewed and changed were made to reflect the requirements. 2. Please consider revising your Abstract and make sure it it structured in terms of clearly defined background, objective, methods, result, conclusions. Refer to our submission guidelines for further guidance (https://journals.plos.org/plosone/s/submission-guidelines#loc-abstract). In addition, please refrain from stating p values as 0.000, either report the exact value or use the format p<0.0001. The abstract was revised to follow the suggested structure. P values were modified. 3. PLOS requires an ORCID iD for the corresponding author in Editorial Manager on papers submitted after December 6th, 2016. Please ensure that you have an ORCID iD and that it is validated in Editorial Manager. To do this, go to ‘Update my Information’ (in the upper left-hand corner of the main menu), and click on the Fetch/Validate link next to the ORCID field. This will take you to the ORCID site and allow you to create a new iD or authenticate a pre-existing iD in Editorial Manager. Please see the following video for instructions on linking an ORCID iD to your Editorial Manager account: https://www.youtube.com/watch?v=_xcclfuvtxQ An ORCID was created and validated. 4. Please amend your manuscript to include your abstract after the title page. The abstract was added after the title page. Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0233344.r002
20 Mar 2020 Decision Letter - Kimmo Eriksson, Editor PONE-D-19-35066R1 Understanding the association between parental attitudes and the practice of female genital mutilation among daughters PLOS ONE Dear Dr. Cappa, Thank you for submitting your revised manuscript to PLOS ONE. I have read it and I don't think I need to send it out on further review. However, I have some minor concerns I want you to address in a second revision. 1. In your response to Reviewer 2, you give reasons for not distinguishing between different types of cutting. I accept these reasons. However, in the method section of the manuscript you need to report what types of cutting are included in the FGM measure you report, and you need to briefly state why different types are treated as a single category in your analysis. 2. In the Figure 1 note, I think the sentence "Due to rounding, values will not add exactly to 100%" should be removed (it only applies to the table, right?). 3. In the Figure 1 note, add a sentence about the accuracy of these percentages, e.g., "The width of 95% confidence intervals for these percentages were typically just a few percentage points, see Table S1." 4. In Figure 2, confidence intervals should be included as error bars in the bar diagram. 5. State explicitly which null hypothesis the p-values refer to. My guess is that the null hypothesis (that you reject in all countries except one) is "the prevalence of FGM does not depend on parents' opinions". We would appreciate receiving your revised manuscript by May 04 2020 11:59PM. When you are ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. To enhance the reproducibility of your results, we recommend that if applicable you deposit your laboratory protocols in protocols.io, where a protocol can be assigned its own identifier (DOI) such that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). This letter should be uploaded as separate file and labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. This file should be uploaded as separate file and labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. This file should be uploaded as separate file and labeled 'Manuscript'. Please note while forming your response, if your article is accepted, you may have the opportunity to make the peer review history publicly available. The record will include editor decision letters (with reviews) and your responses to reviewer comments. If eligible, we will contact you to opt in or out. We look forward to receiving your revised manuscript. Kind regards, Kimmo Eriksson, Ph.D. Academic Editor PLOS ONE [Note: HTML markup is below. Please do not edit.] [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files to be viewed.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0233344.r003
Revision 2
1 May 2020 Author Response 1. In your response to Reviewer 2, you give reasons for not distinguishing between different types of cutting. I accept these reasons. However, in the method section of the manuscript you need to report what types of cutting are included in the FGM measure you report, and you need to briefly state why different types are treated as a single category in your analysis. A sentence was added to describe the type of FGM included in the analysis. 2. In the Figure 1 note, I think the sentence "Due to rounding, values will not add exactly to 100%" should be removed (it only applies to the table, right?). The sentence above was removed. 3. In the Figure 1 note, add a sentence about the accuracy of these percentages, e.g., "The width of 95% confidence intervals for these percentages were typically just a few percentage points, see Table S1." Confidence intervals were added to Figure 1. 4. In Figure 2, confidence intervals should be included as error bars in the bar diagram. Confidence intervals were added to Figure 2. 5. State explicitly which null hypothesis the p-values refer to. My guess is that the null hypothesis (that you reject in all countries except one) is "the prevalence of FGM does not depend on parents' opinions". The null hypothesis was made clear in the section on methods and the main finding in terms of statistical association was emphasized in the section on results. Attachments Attachment Submitted filename: Response to reviewers - 1 May.docx https://doi.org/10.1371/journal.pone.0233344.r004
5 May 2020 Decision Letter - Kimmo Eriksson, Editor Understanding the association between parental attitudes and the practice of female genital mutilation among daughters PONE-D-19-35066R2 Dear Dr. Cappa, 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. Within one week, you will receive an e-mail containing information on the amendments required prior to publication. When all required modifications have been addressed, you will receive a formal acceptance letter and your manuscript will proceed to our production department and be scheduled for publication. Shortly after the formal acceptance letter is sent, an invoice for payment will follow. To ensure an efficient production and billing process, please log into Editorial Manager at https://www.editorialmanager.com/pone/, click the "Update My Information" link at the top of the page, and update your user information. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, you must inform our press team as soon as possible and no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. With kind regards, Kimmo Eriksson, Ph.D. Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0233344.r005
Formally Accepted
12 May 2020 Acceptance Letter - Kimmo Eriksson, Editor PONE-D-19-35066R2 Understanding the association between parental attitudes and the practice of female genital mutilation among daughters Dear Dr. Cappa: I am pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please notify them about your upcoming paper at this point, to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. For any other questions or concerns, please email plosone@plos.org. Thank you for submitting your work to PLOS ONE. With kind regards, PLOS ONE Editorial Office Staff on behalf of Prof. Kimmo Eriksson Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0233344.r006

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