Trends and predictors of change of unmet need for family planning among reproductive age women in Ethiopia, based on Ethiopian demographic and health surveys from 2005–2016: Multivariable decomposition analysis

Abiyu Abadi Tareke; Ermias Bekele Enyew; Berhanu Fikadie Endehabtu; Abiy Tasew Dubale; Habitu Birhan Eshetu; Sisay Maru Wubante

doi:10.1371/journal.pone.0272701

Peer Review History

Original SubmissionMay 30, 2021
25 Feb 2022 Decision Letter - Jianhong Zhou, Editor PONE-D-21-17862 Trends and Predictors of Change of Unmet Need for Family Planning among Reproductive Age Women in Ethiopia , based on Ethiopian Demographic and Health Surveys from 2005-2016: Multivariate Decomposition Analysis PLOS ONE Dear Dr. Tareke, 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. Please submit your revised manuscript by Apr 09 2022 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. 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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 was an interesting paper, addressing an important topic using generally appropriate methods and a sound data set. However, there were a number of issues with the paper, including formulation of the models, discussion of the results, and quality of the prose and editing which mean that it would need a considerable amount of work for it to be suitable for publication. 1. One of my main areas of concern revolves around the definition of the dependent variable, lines 97-102; “The outcome variable was unmet need for FP, where it composed of unmet need for spacing and limiting. It refers to the proportion of women who desire to either delay the next pregnancy or limit future pregnancies but are not using any method of modern method of contraception (11). The outcome variable was categorized as “unmet need” if women had unmet need for spacing and limiting were and coded as 1, while those using FP methods for spacing or limiting or with no unmet need were “met need” coded as 0”. But to my understanding, unmet need considers not only sexually active women who desire to delay/limit future pregnancies but it includes those who were currently pregnant and gave birth recently, whether the pregnancy or recent birth was wanted or not (Look the framework below). How do you justify this? 2. My next concern is, Abebaw et al, 2015 tried to address the issue with a similar procedure and dataset see, https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0116525 What is your contribution? 3. The discussion would benefit from a clearer distinction between contributions to the unmet need change as found here to result from changes in 1) the characteristics of women and 2) the correlates (or effects) of these characteristics with (on) contraceptive use. Finally, in my opinion, the manuscript could be considered for publication but prior to publication minor revisions are suggested to improve the manuscript. Reviewer #2: Dear authors, Unmet need for family planning is an important study to address the trends and predictors factors. This is an interesting study and the authors have conducted. The paper is generally well written and structured. However, in my opinion the paper has some issues that need to consideration. Below I have provided numerous recommendations. Introduction: Please focus could be on the entire Ethiopia context. It be more specific. Methods, The authors should provide clear the study design. Could you please provide the clear inclusion and exclusion criteria that you developed prior to recruitment of the study participants? Please provide the wealth status measurement. Please provide the knowledge about family planning measurement. Please provide the perceived distance to health facility measurement. Could you please provide the used appropriate statistical analysis to control and adjust of the effects of confounding factors? Discussion Please clarify the methodological limitations of study with scouse on risk of biases. Could you please provide application of study findings in education, policy making and future research. ****** 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: Yes:** Dr Zeinab Hamzehgardeshi, Associate Professor in Reproductive Health, Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran [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.] 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 PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: PLOS comments.docx https://doi.org/10.1371/journal.pone.0272701.r001
Revision 1
30 Mar 2022 Author Response Author’s response to reviews Title: Trends and Predictors of Change of Unmet Need for Family Planning among Reproductive Age Women in Ethiopia, based on Ethiopian Demographic and Health Surveys from 2005-2016: Multivariate Decomposition Analysis Authors: Abiyu Abadi Tareke (abiyu20010@gmail.com) Ermias Bekele Enyew (Ermiashi@gmail.com) Version: 1 Date: March 30, 2022 Author’s response to reviews: Plos one Point by point response for editors/reviewers comments Manuscript title: Trends and Predictors of Change of Unmet Need for Family Planning among Reproductive Age Women in Ethiopia, based on Ethiopian Demographic and Health Surveys from 2005-2016: Multivariate Decomposition Analysis Manuscript ID: PONE-D-21-17862R1 Dear editor/reviewer: Dear all, We would like to thank you for your substantial, enlightening and positive comments that you give us. Your valuable comments would progress the substance and content of this manuscript. We tried to account each comments and clarification questions of editors and reviewers in a focused way. Our point-by-point responses to each comment and questions are detailed on the following pages. Further, the details of changes were shown by track changes in the supplementary document attached. Response to Editors and reviewers’ comments Reviewer 1 comment: This was an interesting paper, addressing an important topic using generally appropriate methods and a sound data set. However, there were a number of issues with the paper, including formulation of the models, discussion of the results, and quality of the prose and editing which mean that it would need a considerable amount of work for it to be suitable for publication. 1. One of my main areas of concern revolves around the definition of the dependent variable, lines 97-102; “The outcome variable was unmet need for FP, where it composed of unmet need for spacing and limiting. It refers to the proportion of women who desire to either delay the next pregnancy or limit future pregnancies but are not using any method of modern method of contraception (11). The outcome variable was categorized as “unmet need” if women had unmet need for spacing and limiting were and coded as 1, while those using FP methods for spacing or limiting or with no unmet need were “met need” coded as 0”. But to my understanding, unmet need considers not only sexually active women who desire to delay/limit future pregnancies but it includes those who were currently pregnant and gave birth recently, whether the pregnancy or recent birth was wanted or not (Look the framework below). How do you justify this? Authors’ response: thank you reviewer for rising very decisive issue here. Originally, we included women who had unintended pregnancy during the time of data collection (i.e. those with either unwanted or mistimed current pregnancy). But, we didn’t operationalized it well. We re-operationalize under the revised version of this study as “The outcome variable was an unmet need for FP, where it was composed of an unmet need for spacing and limiting. It refers to the proportion of women who desired to either delay the current or next pregnancy or limit future pregnancies but are not using any method of the modern method of contraception. The outcome variable was categorized as “unmet need” if women had unmet need for spacing and limiting were coded as 1, while those using FP methods for spacing or limiting or with no unmet need were “met need” coded as 0.” We have done the whole analysis based on The Ethiopian Demographic Health Surveys (EDHS) guideline. Which defined unmet need for family planning as “Proportion of women who are not pregnant and not postpartum amenorrhoeic and are considered fecund and want to postpone their next birth for 2 or more years or stop childbearing altogether but are not using a contraceptive method, or have a mistimed or unwanted current pregnancy, or are postpartum amenorrhoeic and their last birth in the last 2 years was mistimed or unwanted.” Reviewer 1 comment: My next concern is, Abebaw et al, 2015 tried to address the issue with a similar procedure and dataset see, https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0116525 What is your contribution? Authors’ response: thank you for your comment. Those authors didn’t incorporated the most recent EDHS datasets i.e. 2016. Additionally, they addressed the issue of modern contraception utilization which is opposite to our study concept. We want to show trend of unmet need for family planning from 2005 to 2016 and the principal contributing factors for the decrease or increase of unmet need from 2005 to 2016. Therefore, our study is different in both issue to be addressed and years of surveys of the datasets. Reviewer 1 comment: The discussion would benefit from a clearer distinction between contributions to the unmet need change as found here to result from changes in 1) the characteristics of women and 2) the correlates (or effects) of these characteristics with (on) contraceptive use. Authors’ response: thank you reviewer we made clear demarcation between those two contributors accordingly. Reviewer #2: Dear authors, Unmet need for family planning is an important study to address the trends and predictors factors. This is an interesting study and the authors have conducted. The paper is generally well written and structured. However, in my opinion the paper has some issues that need to consideration. Below I have provided numerous recommendations. Introduction: Reviewer #2 comment: Please focus could be on the entire Ethiopia context. It be more specific. Authors’ response: thank you reviewer to your comment. We tried to concise the introduction part of this study (see the revised version of this manuscript). Method Reviewer #2 comment: The authors should provide clear the study design. Authors’ response: thank you for your constructive comment. We further analyzed secondary data from Ethiopian demographic health surveys, which was conducted using crossectional method of study design. We added the study design to the revised version of this manuscript accordingly. Reviewer #2 comment: Could you please provide the clear inclusion and exclusion criteria that you developed prior to recruitment of the study participants? Authors’ response: thank you for your concern. As we further analyzed the 2005, 2011, and 2016 EDHS, we didn’t have the option to include or exclude study participants. This is because of the process of including and excluding study participants was held during the time of data collections. But, each EDHS reported that women who were postpartum amenorrhoeic, who were considered fecund, who were using family planning, who want to be pregnant sooner were excluded from their initial study. Reviewer #2 comment: Please provide the wealth status measurement. Authors’ response: thank you for your positive comment. Wealth status related information was taken directly as it appears in the EDHS reports. But, the EDHS program calculate wealth index of each household according to their wealth in cash (number) and in kinds of consumer goods households own and housing characteristics. These scores are derived using principal component analysis (PCA). Therefore, we didn’t take any participation in measurement of this variable rather than using as it is. Reviewer #2 comment: Please provide the knowledge about family planning measurement. Authors’ response: thanks for your constructive comment. This variable is operationalized and corrected accordingly (see the revised version of this manuscript). Reviewer #2 comment: Please provide the perceived distance to health facility measurement. Authors’ response: thank you for your productive comment. The EDHS program didn’t measure the exact distance from interviewee’s home to a health facility. Rather, the data collector asks the study participants “what is seems perception of participants the distance to health facility”. In particular, Women were asked whether the distance to a nearby health facility is a big problem in seeking medical advice or treatment for themselves when they are sick. In our opinion, further operational definition is not required for this particular variable and it is straight forward. Reviewer #2 comment: Could you please provide the used appropriate statistical analysis to control and adjust of the effects of confounding factors? Authors’ response: again many thanks. As we utilized STATA software to run the regression commands, the software will automatically reject if there are confounders because of STATA is different and robust package in auto removing confounding variables. In addition to this, to nullify confounding factors, we utilized bivariable and multivariable decomposition analysis and variable having p-value less than 0.2 are incorporated into the multivariable model and those greater than or equal to 0.2 were not utilized for multivariable. Therefore, utilization of multivariable analysis is one of the mechanism to remove confounding effect. Discussion Reviewer #2 comment: Please clarify the methodological limitations of study with scouse on risk of biases. Authors’ response: many thanks for your comment. More things regarding bias are added to the manuscript (see the new version of this manuscript). Reviewer #2 comment: Could you please provide application of study findings in education, policy making and future research. Authors’ response: thank you. Additional explanation were boosted to the revised manuscript according to your comments. Attachments Attachment Submitted filename: Point-by-point response to reviewers on unmet need.docx https://doi.org/10.1371/journal.pone.0272701.r002
6 Jul 2022 Decision Letter - Thomas Phillips, Editor PONE-D-21-17862R1Trends and Predictors of Change of Unmet Need for Family Planning among Reproductive Age Women in Ethiopia , based on Ethiopian Demographic and Health Surveys from 2005-2016: Multivariate Decomposition AnalysisPLOS ONE Dear Dr. Tareke, 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 reviewers are now satisfied with your manuscript and their comments are below. However we request you thoroughly copyedit your manuscript for language usage, spelling, and grammar. If you do not know anyone who can help you do this, you may wish to consider employing a professional scientific editing service. Whilst you may use any professional scientific editing service of your choice, PLOS has partnered with both American Journal Experts (AJE) and Editage to provide discounted services to PLOS authors. Both organizations have experience helping authors meet PLOS guidelines and can provide language editing, translation, manuscript formatting, and figure formatting to ensure your manuscript meets our submission guidelines. To take advantage of our partnership with AJE, visit the AJE website (http://learn.aje.com/plos/) for a 15% discount off AJE services. To take advantage of our partnership with Editage, visit the Editage website (www.editage.com) and enter referral code PLOSEDIT for a 15% discount off Editage services. If the PLOS editorial team finds any language issues in text that either AJE or Editage has edited, the service provider will re-edit the text for free. Upon resubmission, please provide the following: · The name of the colleague or the details of the professional service that edited your manuscript · A copy of your manuscript showing your changes by either highlighting them or using track changes (uploaded as a supporting information file) · A clean copy of the edited manuscript (uploaded as the new manuscript file) Please submit your revised manuscript by Aug 20 2022 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. 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). 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[Note: HTML markup is below. Please do not edit.] 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: All comments have been addressed Reviewer #2: All comments have been addressed ******** 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 ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 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 ****** 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 ****** 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: (No Response) Reviewer #2: (No Response) ****** 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. 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: Yes:** Dr Zeinab Hamzehgardeshi, BMid, MMid, Edu PhD Reproductive Health., Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran [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.] 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 PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0272701.r003
Revision 2
10 Jul 2022 Author Response Authors’ response to reviews Title: Trends and Predictors of Change of Unmet Need for Family Planning among Reproductive Age Women in Ethiopia , based on Ethiopian Demographic and Health Surveys from 2005-2016: multivariable Decomposition Analysis Authors: Abiyu Abadi Tareke (abiyu20010@gmail.com) Ermias Bekele Enyew (Ermiashi@gmail.com) Berhanu Fikadie Endeabatu (berhanufikadie@gmail.com) Abiy Tasew Dubale(abiytasewhi@gmail.com) Habitu Birhan Eshetu (sisay419@gmail.com) Sisay Maru Wubante(sisay419@gmail.com) Version: 1 Date: 10 July, 2022 Author’s response to reviews: BMC Health Services Research Point by point response for editors/reviewers comments Manuscript title: Trends and Predictors of Change of Unmet Need for Family Planning among Reproductive Age Women in Ethiopia , based on Ethiopian Demographic and Health Surveys from 2005-2016: multivariable Decomposition Analysis Manuscript ID: ccc25ca3-db68-48c6-87d6-65d9d0770161 Dear editor/reviewer: Dear all, We would like to give deep gratitude for your constructive and fruitful comments. You valuable comments enhanced content of the manuscript and we got highly experienced of scientific paper writing. The authors accounted each comments and clarification questions of editors and reviewers in a focused way. Our point-by-point responses to each comment and questions are detailed on the following pages. Further, the details of changes were shown under track changes in the supplementary document attached. Response to Editors and reviewers’ comments Editors’ request: The name of the colleague who edited your manuscript? Authors’ response: The name of the colleague who helped us in editing and improving the English language of our manuscript was Bayley Adane Takele. He has MPH in biostatistics and 5 years’ experience in scientific paper writing specially in health related manuscript writing. Attachments Attachment Submitted filename: response to reviewers.docx https://doi.org/10.1371/journal.pone.0272701.r004
26 Jul 2022 Decision Letter - James Mockridge, Editor Trends and Predictors of Change of Unmet Need for Family Planning among Reproductive Age Women in Ethiopia, based on Ethiopian Demographic and Health Surveys from 2005-2016: Multivariable Decomposition Analysis PONE-D-21-17862R2 Dear Dr. Tareke, 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. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. 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 help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- 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. Kind regards, James Mockridge Staff Editor PLOS ONE https://doi.org/10.1371/journal.pone.0272701.r005
Formally Accepted
9 Aug 2022 Acceptance Letter - James Mockridge, Editor PONE-D-21-17862R2 Trends and Predictors of Change of Unmet Need for Family Planning among Reproductive Age Women in Ethiopia, based on Ethiopian Demographic and Health Surveys from 2005-2016: Multivariable Decomposition Analysis Dear Dr. Tareke: I'm 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 let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, 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. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr James Mockridge Staff Editor PLOS ONE https://doi.org/10.1371/journal.pone.0272701.r006

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