PONE-D-20-25718

Family planning in Pacific Island Countries and Territories (PICTs): A scoping review

PLOS ONE

Dear Dr. Harrington,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

The article is a scoping review, which PLOS ONE considers to be in scope as a type of systematic review and/or meta-analysis. Our author guidelines for systematic reviews/meta-analyses are at http://journals.plos.org/plosone/s/submission-guidelines#loc-systematic-reviews-and-meta-analyses. The required PRISMA-ScR checklist is provided (S2 table) as well as the flowchart (figure 1).

There are concerns raised by the reviewers on the selection of sources. It seems that the review is missing an important part of the literature both from peer-reviewed references and from the grey literature. These concerns should be addressed in order to provide a balanced view of what is known regarding FP in the pacific.

1. In particular, it seems that the search has not been as systematic as desirable regarding grey literature. There are evident places where it is necessary to look that have not been inspected. In particular, the United Nations Population Division publishes every two years the database on World Contraceptive Use (the last one from 2020), that includes sources. The contents of this database provide the primary evidence for monitoring of family planning SDGs. For each of these sources there generally is a survey report. Many are missing, as pointed out by reviewer 2 regarding MICS/DHS surveys. The same applies to work connected with FP from international organizations as commented by reviewer 2, including UNFPA needs assesments which should be available from UNFPA regional websites, and HIV/AIDs surveillance studies and youth risk behavior surveys from the region (reviewer 2). It seems the protocol was not working in this case. In this respect the pacific data hub https://pacificdata.org/ , SPCs Central Data Catalog, https://microdata.pacificdata.org/index.php/catalog that generally includes the survey reports, in addition to UNFPA and the UN Population Division are places that must be considered.
2. Reviewer 1 identified loopholes in the protocol that lead to relevant studies from peer reviewed sources not being included, including not looking for the individual country names separately. These should also be addressed.
3. In order to better place the study in context, as suggested by reviewer 3, a small summary regarding contraceptive prevalence and unmet need for family planning in the region compared to other relevant regions based on international data would enrich the study.
4. There are also comments and suggestions by reviewers 1 and 3 regarding the interpretation of results, in particular in connection with the role of religion.

In any case, it is felt that a major write-up would be required since a more inclusive analysis of published reference might well lead to different conclusions. That is the first step that needs to be done in order to make the results of the analysis trustworthy.

Please submit your revised manuscript by Jan 02 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're 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.

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We look forward to receiving your revised manuscript.

Kind regards,

José Antonio Ortega, Ph.D.

Academic Editor

PLOS ONE

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2. Please update the literature search to include publications since 2018.

3. We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions.

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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: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

Reviewer #2: N/A

Reviewer #3: N/A

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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: No

Reviewer #2: Yes

Reviewer #3: Yes

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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

Reviewer #3: Yes

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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: Abstract

Authors highlighted the role of “culture and religion” as the main barriers of accessing family health services. It was extracted form the reference 36 and 42 while these two main findings are not presented in the data extraction sheet. Moreover, it is very difficult to accept, in Pacific country. Culture and religious always play the role as barrier.

Introduction

1. Overall, this section mostly focuses on history of family planning instead of the importance, challenges and actually the gap which leaded to conduct this research.

1- Page 3, line 2, please remove the dot (.) before the reference 1 in page 3.

2- Page 3, line 7, it is needed to use (SRH) after the “sexual and reproductive health” as the abbreviation is used later.

3- Page 4, last line, you can only use “SRH” instead of the full words.

4- Page 6, line 4, you can only use “SRH” instead of using its complete words.

Method:

1- Overall, this section lacks a good search strategy, appraisal process, and extracting data.

2- Page 6, the last 3 lines, you can use “STH” instead of suing its complete words.

3- Page 6, the last 2 line, you can use “PICs” after “Pacific Island Countries”.

4- Page 7, number 4, it is not clearly mentioned the period/time of searching paper. What does “Current” mean in the sentence “Published between 1994 and current”?

5- Page 7, line 6, you can use “SRC” instead of “sexual reproductive health”.

6- Page 7, lines 4 and 5 of “Information sources and search”: why you used * after melanesia* polynesia* micronesia*? This is not correct usage of (*).

7- Page 7, lines 4 and 5 of “Information sources and search”: it is needed to use “OR” between “Melanesia, Polynesia, micronesia”.

8- Using a keywords of “pacific island countries and territories” is a keywords that caused authors to lose many studies. It can be searched even using “Pacific” or the names of each Pacific countries (as listed in page 5 of “Introduction” to allow authors to find relevant studies. For example, I know there are more than 5 studies that are published by this reviewer while the author lost in this search. They are available in google scholar as the authors mentioned they used it for their search.

9- Page 7, lines 4 and 5 of “Information sources and search”: it is not clear why the authors used (*) after “challenge*, success*, barrier, enabler”? Using (*) is only to find the words that are similar such as “Prevention OR preventive”. In this case they could use “Prevnti*”.

10- Page 7, Lines 4 and 5 of “Information sources and search”: authors could use “OR” to include more synonyms and allow the databases to find more studies. For example it should be searched like “barrier OR Challenge OR obstacle”…. This caused authors to lose many studies.

11- Same comments for “wom?n OR m?n OR “young people”. That is one of the reasons that authors lost many relevant studies.

11- Page 7, second paragraph of “Information sources and search”: it is not clear why and how the authors chose “SCOPUS, MEDLINE and CINAHL” as databases for the search? There are other relevant databases that could help them to reach more relevant studies like CINAHL, PsycInfo.

12- Page 8, line 6, it is better to mention “data extraction sheet” instead of “Key findings” as this table presents all the information extracted for the selected studies.

13- Page 9, please remove “missing full text” from the box that included 73 studies. This stage authors just focuses on the title and abstract NOT the full text.

14- Page 9, last box where the “Inclusion” is achieved, the types of studies should be presented instead of writing only 22.

15- This section there is no any information about studies appraisal. If authors used PRISMA checklist, they could assess the quality of studies to include high quality studies in the analysis.

16- The main issue in this section is authors didn’t do bibliography search of remained 22 studies (after the last stage). That is why they lost many studies that may not published in the selected databases and other sources but they could easily find them in the bibliography.

Results:

1- Overall, this section is written well but there are many results that are extracted from the 22 studies that were included in the final analysis. This is the big issue.

2- Page 10, line 2 of “results”: authors written “Based on title and the abstract, 73 were excluded”. This has been presented incorrectly in PRISMA flow chart present before that. They believe they considered the full text too.

3- I strongly believe, authors lost many studies that could be included in this study. It is not correct that only 12 original studies are conducted on family planning in Pacific. There is a big gap between the found studies and real available studies.

4-. Page 11, Table 4, the tile should be “data extraction sheet”.

5- There are many information extracted from the studies that are not presented in Table 1 while they are presented in the finding section. For example “culture and religion” was considered as the main berries for theme “Enabling factors”. The reference 32 and 46 were authors got this findings while there is no any information about the barriers from these two references in Table 1. There are many other similar errors that shows authors extracted results while these key findings are not presented in the Table 1.

6- Page 18, line 2 of “Geographical isolation and access” the results extracted is form the reference 6 while this reference is not belong the 22 studies summarized in Table 1.

7- Page 18, line 10, same wrong issues has happened. There is no any reference 6 and 12 as the studies that were summarized in Table 1 while the results extracted form these references.

8- Page 18, line 2 of “Socio-cultural beliefs and influences” there is results extracted form reference 49 while this reference is not part of 22 studies that summarized in Table 1.

Discussion:

1- This section is written very poor. There is no good justifications for many results presented in the results section.

2- Page 21, line 11, authors are using SRH while they could use this abbreviation earlier as I mentioned in my previous comments.

Limitations:

There are lots of limitations that authors didn’t mentioned in this section.

Reviewer #2: Congratulations to the authors on a solid research paper and shining the light on family planning services and uptake in the Pacific region as there is not enough research about these broader dimensions of sexual and reproductive health and rights. The conclusions are valid based on the 22 papers reviewed. I would like to qualify this feedback in the context that this is the first time I have participated in a review such as this and I hope I have followed the guidelines correctly.

In terms of suggestions of how the paper might be improved and references to human rights, perhaps the scope of the (normative) frameworks should encompass not only ICPD, MDGs and SDGs; but also the Beijing Declaration and Platform for Action, as well as specific reference to CEDAW, CRC and CRPD etc. to strengthen the reference to human rights. The introduction could potentially include references to public/private SRH providers and increasing use of emergency contraceptives, traditional family planning practices, increasing use of the private sector because of perceived limitations through state clinics, the evolution of SRH in education curriculums and the ‘family life’ model, drawing from the Demographic and Health Surveys ‘empowerment’ findings and teasing out women’s limited autonomy over decision making to name but a few. However, if as it seems, this information wasn’t gleaned from the search results, then perhaps some more general references to these broader issues could be incorporated in the narrative.

However, I am somewhat perplexed and surprised by the overall search results, noting the rigorous method and criteria employed. For example, I would have thought that the search would have returned papers either referring to or specifically about:

• Second generation surveillance for HIV/AIDs studies conducted throughout the region that focused on youth and SRH etc;

• Demographic and Health Survey reports from almost all PICs governments, with the search only finding the Solomon Islands DHS report (Please note the correct survey name for page 7); and

• UNFPA SRH Needs Assessments Health Facility Readiness Assessments as well as the RMNCAH Workforce Assessment – for a number of PICs as well as the Solomon Islands.

It would be good if references to the dates of the publications ‘published between 1994 and current’, ‘published between 1994 and 2019’ used in the paper, are consistent and more precise in terms of ‘published between 1994 and <<month>> 2019’.

As noted, I stand ready to revise this based on feedback from the editor.</month>

Reviewer #3: On the overall, the conclusions the author has made are accurate. It would be good to note, that not all of the Pacific Island countries are equally in their development status, and a history of conflict in countries like PNG and the Solomon Islands which delay progress towards development. In the early part of the paper, it may be useful to utilise data on the gaps ie unmet need and contraceptive prevalence rates in the PICTs to illustrate the lack of uptake, and hence the need for this paper. This data is available through reports such as the Demographic Health Surveys, and the World Contraceptive Use Reports by the UN Population Division. This can help show the differences between the PICTs, and other countries, as well as progress made over time.

The effect of culture and religion in the Pacific islands on issues of sexuality and reproduction, and women’s rights cannot be underestimated. In fact two of the seven countries – who have not signed or ratified CEDAW come from the PICTs – Tonga (not signed, not ratified) and Palau (signed, not ratified) along with countries like the Holy See, the US, Iran, Sudan and Somalia. Additionally, in the introduction, the authors write that in response to China’s practices of coercive contraception and abortion, the Holy See issued a strong stance to these issues - (In response to the controversy, the Roman Catholic Church prohibited all artificial contraception and made a strong stand against abortion as a method of family planning [11].)

This is inaccurate as 1) the Holy See has had centuries-long tussle on the issue of abortion (beliefs ranging from early abortion ie before ensoulment was not murder, until 1869 all forms were outlawed) and contraception prior to China’s actions. 2) The Catholic Church’s stance against abortion is not only as a “method of family planning” but for even therapeutic reasons – rape, birth defects.

An older study – but still useful to consider is Donald P Warwick’s 1988 “Culture and the Management of Family Planning Programs” published by Population Council, which brings together key considerations which include aspects such as kinship ties, value of children, communal divisions which help advance or hold back success of contraceptive programmes. Some of these factors may also be at play in the PICTs, rather than just ‘religious resistance.’

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Reviewer #1: No

Reviewer #2: Yes: Kim Robertson, Gender Statistics Advisor, SPC

Reviewer #3: No

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Family planning in Pacific Island Countries and Territories (PICTs): A scoping review

PONE-D-20-25718R1

Dear Dr. Harrington,

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

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

José Antonio Ortega, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Congratulations on a much improved manuscript!

While both reviewers indicate a minor revision, it is felt that the suggested very minor issues can be dealt with without the need for a subsequent round of revisions.

As reviewer 1 states, before publication please ensure to be systematic in the way contraceptive prevalence is reported for survey data in table 1, including always the rate for all women and for women in union (or married, depending on the survey definition). The rates provided now do not have a qualification and are not systematic making them useless.

See also a minor typo also pointed out by reviewer 1.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

Reviewer #2: All comments have been addressed

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2. 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: Yes

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

Reviewer #2: N/A

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4. 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

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5. 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

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6. 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: Result section- Page 25, sub-title “Family planning services in the Pacific”. Please correct “Thirteen papers [5, 44, 52, 56, 61, 64-67, 70, 74, 77] described government…”. There are only 12 references. This should be 13 references

Reviewer #2: Authors have made revisions to address reviewer comments given the research methods and criteria etc with the limitations of the method being very clear.

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7. 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.

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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

Attachments

Attachment

Submitted filename: FFP in PICTs A scoping review - Reviewer Comments KimR.docx