PONE-D-21-23985

Determinants of modern contraceptive use among men in Pakistan: evidence from Pakistan demographic and health survey 2017-18

PLOS ONE

Dear Dr. Ali,

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.

Three reviewers have provided detailed comments on the manuscript that requires changes including in the language. For completeness of reporting, PLOS ONE strongly suggests the inclusion of a relevant checklist for observational study such as the STROBE checklist (https://www.strobe-statement.org).

Please submit your revised manuscript by May 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. 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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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: Partly

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

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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: Yes

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: No

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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: The research article “Determinants of modern contraceptive use among men in Pakistan: evidence from Pakistan demographic and health survey 2017-18” uses secondary data analysis of Pakistan Demographic and Health Survey (DHS) to explore the determinants of modern contraceptive use among men.

The study is important as the unmet need for family planning in Pakistan is high and male´s attitudes regarding contraception are an important part of fertility rates.

Background

Consider changing the word “determinants” to “factors associated with”, as DHS do not have a longitudinal design, thus cannot be utilized to study causality.

The author says that U$ 55 are spent per woman, but it is not clear if it is a yearly rate.

As much as the authors cite the relevant factors that matter for the utilization of modern contraceptive among men and bring some of these factors in the discussion (socioeconomic status, education, cultural beliefs, area of residence, religion and wrong perceptions about family planning), it would be interesting to hear more about these mechanisms up front. I would add a section containing a brief review of these factors, especially because testing these elements is the main goal of these analyses.

The same goes for research studies “exploring the predictors of contraceptive use among couples have overlooked the role of men”. The authors should bring more of this literature and how their study contributes to this framework.

The following phrase is misplaced: “In agriculture based societies, men usually wish to have large number of children because they serve as a source of livelihood. This perception of men creates hinderance in the utilization of contraceptives by couples [18][19][20]”. This is an example of a mechanism and should be included in the section I suggest you add.

The findings would also benefit from more background regarding the regions explored (Punjab, Sindh, KPKa, and so on). Why would I expect regions to differ regarding contraception use? Could levels of development and indicators of gender equity (such as female illiteracy rate) be used to explain some of these differences observed? What has the literature said of these places? You explain Punjab may have improved the structure of family planning services. I would like to hear more about it.

In the end of the Background section, the authors highlight the importance of their findings to frame family planning programs considering the role of men as decision makers in the matters of family planning and reproductive health in patriarchal societies. I think this is gold and should be brought up again in the results with clear and stated recommendations.

I also suggest you enrich your review by bringing information about factors associated with contraceptive use for Pakistan women.

Methods

The analysis was done carefully and the method is adequate for the research question. However, I think it is important to insert controls for parity and if men are sexually active.

I also think it would be good to leave age as a continuous variable, unless you have reasons to believe those three age groups should remain separate.

Being a DHS, it is important to provide information regarding survey weights and sampling.

I understand that calculating a Wealth Index using quintiles would automatically separate the observations into five groups with approximately the same number of respondents. So, these phrase is irrelevant: “Each wealth quintile had an approximately similar number of respondents”.

Regarding the logistic regression, I understood from the text that authors only used in the multivariate analysis the variables that had been found to be significant in the bivariate model. However, by looking at Table 3, all variables were included (indeed, they are all significant at the bivariate model). I would add a phrase explaining that they are all significant. If it is not what you did, please, clarify.

Conclusion

I think this manuscript would benefit from a Review as it has the potential to make a good contribution in its field.

Reviewer #2: The question of fertility plays a vital role in many countries’ economic development and health objectives, including Pakistan. It is, therefore, an important area for investigation and the use of large datasets such as the demographic and health survey (PDHS). I appreciate the authors’ curiosity and diligence in investigating this area. Hopefully, my comments can be used to enhance the work.

Introduction

On page 03, line 51, the reference to fertility reduction as being connected to improvements in health and economic activity is a bit vague. Are you referencing individuals or the state of the country as a whole? Also, it is a bit of a nuanced argument that would require some expansion. However, your study seems more concerned with reaching the male population and less of the significant picture objectives, perhaps focusing on the male perspective. Why have males historically been left out of the conversation on family planning? Why has it taken so long to recognize the importance of reaching out to males in that space? Why have previous efforts tended to focus on women?

On page 4, Line 73 -Line 74, you refer to the United Nations International Conference on Population and Development. That was more than a generation ago, and there have been many iterations of global, regional, and country-specific policies and objectives that have addressed some of the questions you are investigating in this paper. Perhaps you should reference something more recent (e.g., the Millennium Development Goals, followed by the SDGs). Even the UN ICPD had a 25th reunion (i.e., the Nairobi Summit). How have such global structures framed the issue of fertility and contraceptive use behaviors?

Methods

The methods read as straightforward and well-executed. I have nothing to add to this section except for the choice of the conceptual framework. Why was that framework chosen? What is the justification for choosing to look at the variables of interest through that lens? Several conceptual frameworks have been used over the years to explain contraceptive use and family planning behaviors (e.g., USAID’s Conceptual Framework and the Women’s and girls’ empowerment in sexual and reproductive health (WGE-SRH) framework). Why did you eschew other frameworks in favor of this one?

As a note, Figure 01 is blurry, and I think you should find a better image that is clearer and easier to read.

Results

Be careful of the language you employ in describing your results. For example, in the results section, you use the terms likelihood and odds interchangeably. Though they are used to mean the same thing in colloquial usage, “odds” references a particular relationship between the ratio of probabilities (see pg. 10, Line 171 compared to Line 175).

Also, be sure to state that a finding is statistically significant and not just significant. Again, statistically significant as a technical term references something particular, while a finding being “significant” can have a more general meaning, such as being generally important or worth noting.

Discussion

The paper’s discussion section is an excellent place to explore your findings and their potential impact. As I read through this section, it mostly reads as a reiteration of the results section. Try exploring some of the following areas:

Given that in the introduction, you mention that your findings may be used to inform policy, I was hoping the discussion would delve into some commentary about Pakistan’s policy regarding modern contraceptive use if there is one, and how findings can influence that. The fertility challenges have been documented for many decades now and I, as a reader, assume that there are some policies already in place. How do your findings impact those kinds of initiatives? Are men historically excluded from those policies? If men as a subgroup have factored into such initiatives, what do these findings mean?

On pg. 13, Line 217 to Line 222, you note regional differences, particularly between Punjab and other regions. You theorize that it may be due to improve family planning programs. Is it possible to expand a bit on this? What kind of well-structured family planning programs in Punjab make that place more successful than other regions, and why have such policies not been diffused to other regions.

Why do you relate your study findings to findings from places like Uganda and Congo? There is nothing wrong per se with that comparison; I don’t think. You could argue that Pakistan occupies a similar socio-economic bracket as those countries, and hence the way they deal with contraceptive use and family planning behaviors may have some bearing on Pakistan. However, neighboring countries in the subregion (e.g., India, Tajikistan, Afghanistan, and Iran) may offer more forthright comparators. I suggest looking through the literature.

Reviewer #3: Review Comments to the Author

Dear Editor,

Thank you for the opportunity to review the manuscript titled Determinants of modern contraceptive use among men in Pakistan: evidence from Pakistan demographic and health survey 2017-18.

Overall, the manuscript is fairly well written and has clear aims. It also focuses on a topic of deep interest to the reproductive health community and is backed by an extensive body of research. However, I find that the justification for the study and its relative contribution to the existing literature is very weak. As such, the unique contribution of these analysis is unclear to me. I think the authors can make a stronger case if they could point out which variables have not been examined, whether is consensus and variables that have inconsistent results. Please see below my specific comments that could further improve the manuscript.

Introduction

Overall – Fairly clear and well written.

1. There are multiple typos throughout the manuscript. Authors are suggested to proofread them carefully.

2. Consider reporting on how Pakistan compares in relation to regional estimates of modern contraceptive use.

3. Need to define modern contraceptives.

4. If effective strategies need to be country-specific, what was the rationale behind estimating prevalence? The rationale part needs to be strengthened.

Methods

1. Data sources and sampling techniques – could benefit from better organization structure – information seems randomly placed. Also, expand on stratification and provide a reference for a more elaborate description for the DHS sampling strategy.

2. Sample –Provide a justification for your sample selection

3. Please provide another Table and give how each of the independent variables were derived or recoded from the original dataset. This can either be in the manuscript or attached as a supplementary file.

4. Which sampling weight and id were used and was the weight normalized?

5. What informed the inclusion or selection of the independent variables?

6. Please specify the model equation

7. What informed the choice of the reference categories

8. Did the authors check for multi-collinearity, the results should be provided

9. Please use the STROBE guidelines and present it as an appendix or a supplementary file

Results

1. Consider specifying only the key findings of the study rather than listing all the determinants. Also, use the breakdown of the sentences rather than writing one long sentence that is hard to follow.

2. The statistical analysis not been performed rigorously

3. Presentation of results needs to be revised

Discussion

1. Authors started to compare and contrast study findings, which should have been followed after stating the key findings and justification for those findings.

2. There is a repetition of most of the findings that are already stated under the results section.

3. Justification for all the discordant results are presented same i.e., due to differences in sample size, study design, setting, and study population. This needs to be study specific rather than a mere generalization.

Conclusion

1. Clearly and concisely state the conclusions of the study in relation to the key question it sought to answer and the contribution that the paper would make.

2. The conclusion is well presented. However, the policy implications are not well discussed. The authors can consider beefing them up.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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Attachments

Attachment

Submitted filename: Review - PONE-D-21-23985 (1).pdf

PONE-D-21-23985R1Factors associated with modern contraceptive use among men in Pakistan: evidence from Pakistan demographic and health survey 2017-18PLOS ONE

Dear Dr. Ali,

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 same 3 reviewers have evaluated the manuscript finding an important improvement but noting some aspects to change in order for the work to be publishable. Note that reviewer 2 comments are in an external file.

Please submit your revised manuscript by Jul 14 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). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

José Antonio Ortega, Ph.D.

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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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

Reviewer #3: 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

Reviewer #3: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: 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

Reviewer #3: 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

Reviewer #3: 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: Introduction

I would like to say that I apreciate the authors' effort to improve the paper according to the reviewers' points. It has been completely revised and has improved considerably.

One thing to consider is that by adding the information requested by the reviewers, the manuscript lost a lot of its readability. So, I would spend some time trying to improve the flow of information. For example, line 50 mentions the role of contraceptives in preventing maternal mortality, but line 65 bring the proportions of death. Another example further down: Line 252 to 263 brings several short phrases that can be better connected. See for example, that the word Punjab appears 5 times in this solo paragraph. By the way, you improved this part, but I think we need more descriptions of these regions and their components (because maybe the differences we are observing are only compositional effects).

I would like to strength the point that we have here a paper on a topic that is not very well explored, which is male´s involvement in contraceptive use. Studies inquiring males are absolutely necessary in order to help inform reproductive change policies. Nevertheless, for most modern contraceptives, excluding male condom and vasectomies, women are the ones taking the contraceptives, so, any study of male´s contraceptive behavior is at least partially explained by their female partners´s access and use of contraceptive. This should be mentioned upfront as well as an important consideration which is: women might be taking contraceptives without men knowing about them. So, it is important to either compare this distribution to women´s prevalence or at least mention this statement. You are basically evaluating men´s contraceptive use based on what they know is true.

In my previous review, I listed several points that needed to be observed. In this new submission, the authors addressed one by one, like improving the description of mechanisms of various predictors on contraception, adding background information on each of the regional areas, improving the importance of their findings to frame family planning programs considering the role of men as decision makers and also included a short section explaining why men has been left out of the conversation on family planning (as suggested by the other reviewer). However, I would also add the SDGs as your own justification for this kind of work and I would increase this part in the Discussion section as I will explain below.

As no section “Liteture Review” as presented, the authors brings the literature review at the discussion. I don´t personally like this format, but it is ok. I will comment about it at the “Discussion” section.

Methods

As I mentioned before, it would be important to control for parity and sexual activity. As the authors mention that this information could not be retrieved from the dataset, this limitation should be listed in the discussion. The same goes for age as a continuous variable, that they don´t have. The variables “age” and “education were recoded, but it is necessary to provide the original categories. As for the other ones, it is important to specify that they are being used in their original format.

I also think the analysis should be controlled by marital status. Could part of this ever-married men be widow or separated?

I also would like to see a descriptive table of all contraceptive methods before being aggregate into modern or traditional. Mainly because I would like to see if men who use condoms are different from male who use female´s methods. Aggregating into modern methods may make us lose important variability.

As per another reviewer indicated and it remained missing, I think they should include the information about having used man´s sample weights and the information about choice of reference category in the logistic regressions.

Discussion

Again, I think the incorporation of the reviews made the text lose readability. Check, for example, the first paragraph of the discussion. A great start would be to use “The policy paper…(line 227 to 232) ” and then finish with the lines 223 to 227, which are the empirical findings.

The second paragraph also present structural problems that distract the reader. See how both phrases below can be transformed into a single one:

235 - Discussion with a health worker about family planning enhances the knowledge of contraception that ultimately brings a positive change in behavior [27].

237 - Evidence from behavior change models suggest that knowledge is the 238 first step towards change in behavior [28].

You either flip these phrases or reframe them. This happens throughout the Discussion, so be patient to improve these sentences and paragraphs.

As I pointed in the “Introduction” section, here they keep on adding previous empirical evidence found in the literature with which their findings converse. This is important, as I had mentioned in my first review. But in a journal such as PLOS one, you need to go one step further and discuss why it is important to incorporate men (you cite this on line 231 but do not explore) and how your unique findings help frame family planning programs considering the role of men as decision makers. That means: why is your article unique? How can these findings help Pakistan, which have historically excluded men (as pointed by reviewer 3), create policies that will sucessfully envolve men?

The Conclusion section summarizes all of these really well, but the things above mentioned should be first introduced and dissected in the Discussion sections. They all have mechanisms (i.e. female literacy empower women to demand contraceptives? Or female literacy is associated with male´s literacy, so men who with higher levels of education would be more aware about contraceptive methods and will tend to report more).

There is so much to say here and I think the authors could point directly at how these findings inform policy.

By the way, always keep in mind that the statistics pertain to “men´s perception of contraceptive use”. It is possible that women use contraceptives, yet their husbands don´t know or don´t care to know. So what you are measuring is perception, not use. In my understanding, the only “use” you can measure is vasectomies and condoms. Any data on couple´s discordance on contraceptive methods that you could bring? If not, them set this for future studies.

Reviewer #2: (No Response)

Reviewer #3: The manuscript looks good. The authors addressed all the issues I have raised. I have no further comments on the manuscript

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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.

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

Reviewer #3: Yes: Dr. Nitai Roy

[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: Review 02 - PONE-D-21-23985R1.pdf

Factors associated with modern contraceptive use among men in Pakistan: evidence from Pakistan demographic and health survey 2017-18

PONE-D-21-23985R2

Dear Dr. Ali,

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,

Syed Khurram Azmat, PhD, MPH, MD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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 #3: 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 #3: Yes

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

Reviewer #1: Yes

Reviewer #3: Yes

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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 #3: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

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Reviewer #1: Yes

Reviewer #3: 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: I thank the authors for significantly improving the manuscript. I do not have anything else to add to my comments and if the authors have done what they can to address my previous suggestions, I believe it is good for publication.

My only comment is that I am still missing a brief discussion about how you are actually analysing perceptions when it comes to female methods, especially since you find that men who believe contraception is a women's business are less likely to report using contraception. This seems obvious because they might not know about their women's behavior. So, they are less likely to report, but not necessarily less likely to use (a female method, for example, that he is not aware). As you are not pairing women and men's data, there is no way for you to check whether your finding is true. So, I would rephrase your findings to reflect perception, not real behavior.

Reviewer #3: Author's made vast changes in their manuscript. The manuscript is now quite good for publication in PLOS ONE. No additional comments from my side.

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Reviewer #1: No

Reviewer #3: No

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