PONE-D-21-32104‘Decision about number of children should be done by both husband and wife; but the wife should do as her husband advises’: Understanding factors influencing contraceptive use decision making among married Pakistani couples – qualitative study.PLOS ONE

Dear Dr. Sarfraz,

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.

Two reviewers have provided constructive feedback and suggestions to strengthen the manuscript, including clarification of inclusion criteria (and its implications on findings) and further exploration of gender dynamics.

Please submit your revised manuscript by Mar 18 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.

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Hannah Tappis, DrPH, MPH

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

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

Reviewer #1: N/A

Reviewer #2: Yes

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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

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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

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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: Thank you for sharing this interesting and important article. The article is well written and methodologically coherent. The article provides a good overview of some of the key barriers to using LARC as expressed by women and husbands. However, what’s missing is an exploration of the tensions between husbands and wives. Further exploration of these areas where there is a lack of alignment how that translates to practices, method choice, and unmet need would add depth to the article.

I have a few other suggestions/comments to improve the article:

•A more focused analysis of the gender dynamics, a few thoughts for consideration:

o Men’s refusal to participate in study was very high and can lend insights into gender dynamics, and the perception/gender allocation of family planning

o Large discordance between husband wife with respect to previous contraceptive use, specifically with respect to male methods, what does that also teach us about how masculinity is constructed, what insights how confident in measures of unmet need given limited disclosure, might be worth locating analysis in this larger landscape

•Interviews are conducted but husband and wife comments are presented together, please clarify in text

•May be worth mentioning the structural limitations that constrain LARC use in introduction/discussion

Reviewer #2: The paper is well written and provides useful information. There are some minor errors like:

- first sentence of the last para on page 15 is missing a word as its not making sense.

- first sentence on page 26 .....as well has reproductive ...., this should be "as well as reproductive".

I also think that the title is not defining the results very clearly as its not only husbands who influence contraceptive use decision making, but also other family members and religious beliefs. Looking at the results and discussion, it seems the title may highlight the issue of routinely missing men in contraceptive awareness raising and service provision that leaves them too low in knowledge and understanding to be able to support or even guide their wives.

While describing the sampling and inclusion criteria, it is mentioned that only couples not using LARCs were invited for the qualitative study although they were still using short-acting methods. However, the rationale for this selection is not clarified and if similar criteria has been used by other researchers to identify issues around contraceptive use decision making. In addition, it is not mentioned if these couples had any exposure to contraceptive awareness raising programs to determine if their choice of not using LARCs was despite the counseling services or it was due to a weak link in contraceptive counseling programs missing out on husbands and men in general.

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Reviewer #1: No

Reviewer #2: Yes: Dr Qudsia Uzma

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PONE-D-21-32104R1Decision about number of children should be made by both the husband and wife; but the wife should do as her husband advises’: Understanding factors influencing contraceptive use decision making among married Pakistani couples – qualitative studyPLOS ONE

Dear Dr. Sarfraz,

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 Sep 22 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,

Hannah Tappis, DrPH, MPH

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.

Additional Editor Comments (if provided):

Please disregard comments from the first reviewer regarding not seeing a point-by-point response to comments, but do carefully consider their concern regarding the lack of nuance in discussion about cultural context and gender norms, as well as constructive comments from reviewer #3.  

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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: (No Response)

Reviewer #3: (No Response)

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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: N/A

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: No

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 #3: 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: Authors did not adequately address comments about lacing in gender through the manuscript, no point by point rebuttal letter was provided so unable to understand why this decision was made. Current discussion about cultural context and gender norms is reductive and tends to essentialize cultural norms without making space for differences/discussing nuance.

Reviewer #3: Hello - Overall, I thought this research was done well and they found interesting results. Below are some comments/suggestions for authors.

1) Please highlight the implications for change based on the results you found (the "so what" question for your findings); I would also include that as part of the abstract - given what you found, what would you suggest changing.

2) Please emphasize what's different about your study and what your findings add to the current literature.

3) Could you provide more details regarding the translation process in your methods; were the transcripts translated into English and then analyzed?

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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 #3: No

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[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.

'The wife should do as her husband advises’: Understanding factors influencing contraceptive use decision making among married Pakistani couples – qualitative study

PONE-D-21-32104R2

Dear Dr. Sarfraz,

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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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,

Hannah Tappis, DrPH, MPH

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Concerns and feedback shared by peer reviewers has been adequately addressed. Minor copyediting is still needed. For example, in the Introduction there are a few sentences with citations in brackets (e.g. "ref MacQuarrie") that do not follow standard references formats used in the remainder of the manuscript.

Reviewers' comments: