PONE-D-23-10482COVID-19 and Female Genital Mutilation/Cutting and Child Marriage: An online multi-country cross sectional surveyPLOS ONE

Dear Dr. Kpokiri,

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.

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Zeus Aranda, MSc MBA

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: No

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

Reviewer #1: Yes

Reviewer #2: Yes

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: No

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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: Overall a very nice article, interesting study on a relevant topic. The online multi-country cross sectional survey show that in times of COVID 19 both the cases of female genital mutilation and child marriage went up, and the authors conclude as it has these results are based on self-reporting, probably the real figures are higher. Some issues are only presented in the discussion and it is recommended to also integrate them in the results. Link to laws should be taken out.

Some specific comments

Abstract overall informative !

p.1

-Abstract starts with harmful cultural practices and it is maybe better to start with Female genital mutilation etc

- the analysis assessed the impact of COVID-19 restrictions-good already here to present the definition or give examples here.

p.2

- can you give a bit more detail about “ sooner than planned”

- some repetition in the abstract- sooner than plan

- why would strict enforcement of regulations discourage these practices? For both practices there are assumed big rituals at community level, but is this really the case?

Introduction

p. 2

- the substantial economic costs are referenced with the website of WHO is there is no date, please add undated or accessed when. Same for other references

- FGM/C be performed in preparation for child marriage – please rephrase as marriageability was linked to it indeed but in some countries less the case nowadays (CF Kenya) and sometimes first leading to sexual activity and pregnancy.

p.3 Bangladesh reported an increased number of child marriages but studies from before the COVIC period!

p.3 parents to arrange a marriage in time of conflict to protect them from harm? What harm?

Methods and Data Collection are fine but good to explain why there was no option to add a qualitative component to the study.

P. 4 here it is mentioned that FGM/C and child marriage were optional components and included in 14 countries this clarifies why 14 countries reported on it as mentioned in the abstract

p. 5 Table 1; normally you would think a table as this would be better placed at the end of the article but here I think it helps to understand the findings; however maybe both table 1,2,3 at the end?

p.7 Good to give some detailed information why both change in economic situation and educational level were found non-significant.

p.8 why do the authors suspect that so many -23 participants were from Singapore and not from other South Asian countries?

Discussion

p.9 financial problems- do we know more?

p.10 some information about the occurrence of FGM/C in Kenya and Singapore should be better presented in the Results section and only discussed here?

- sooner than planned with reference to Orchid please provide more details

- 1 out of 5 – seems not a high number – how do you explain

p. 11

- the link to study of Esho at all 2022 is fine here, it underlines your findings

- the only 8% of Egypt is indeed surprising – bias to urban settings and becase the syudy was online could also be mentioned in the abstract?

p.12

- link to closing of schools fine, but also maybe already ,mention this in the results and come back to it here?

p. 12 the importance of more stringent laws are not related to this article and the results and should be taken out!! That is a whole other discussion

Reviewer #2: It is important to comprehend how the pandemic has affected harmful practices such as FGMC/C and child marriage. The only comments I have are as follows:

Did COVID-related financial difficulties have the biggest impact on changes in rates of child marriage and genital mutilation? Or were there other COVID-related restrictions that also had an effect?

According to the conclusions, there is a claim that the decision to advance FGM/C during the pandemic is associated with the family's financial situation. However, this claim was not found to be statistically significant.( p=0.07)

Reviewer #3: 1. Is the manuscript technically sound, and do the data support the conclusions? No

The authors make overly broad statements and cite a single reference to support it, which often is not a peer-reviewed journal article.

The authors make misleading statements that their own sources and their own contradict, or at least do not support. One example (among many): “FGM/C may be performed in preparation for child marriage.” Yet the UNICEF report they cite states that “In countries affected by both practices, most women experience neither practice or only one of the two.” Moreover, their own data contradict the statement; only in Portugal does prevalence of FGC correlate with prevalence of child marriage.

A second, more egregious, example: their data shows that 7.7% of participants said they would arrange a marriage for their daughters sooner than planned, 5.3% later than planned, and 1% cancelled marriage plans. Yet in their conclusion, the authors state only that “The findings show that the pandemic has resulted in many families carrying out both practices sooner than planned.” They do not mention that almost as many families postponed or canceled the marriage.

The survey respondents—mostly young, childless, college-educated, urban “participants” associated with a research network—do not represent people who actually perform FGC or child marriage. Almost 60% of the participants are from Mexico (19%) and Portugal (37.6%), out of 14 countries. Mexico has a high prevalence of child marriage but no FGC; Portugal is single digits for both (I assume because of immigrant groups).

Poor presentation of descriptive statistics. One example (of many): “About 13.6% (18/132) of participants intented [sic] to organise circumcision for their daughter.” But there is no explanation of where the 132 denominator comes from. This follows: “Out of these, 19(14.6%) participants intended to circumcise their daughters sooner than planned, while 6 (4.6%) stated later than planned, only one (0.8%) participant cancelled plans for circumcision.” It looks like 18 became 19+6+1.

The authors included opinion questions from “participants” who likely have no real connection with the practices involved, especially FGC.

The questions about planning FCG or child marriage are hypothetical, about intentions and plans, not about real events. Without follow-up, there is no way to conclude that COVID really affected either of the practices.

The authors include two paragraphs (the “implications” paragraph is actual a continuation of limitations) that describe—very well—several limitations, which should have precluded making the conclusions they did and submitting the manuscript for publication.

*2. Has the statistical analysis been performed appropriately and rigorously? No

The numbers of “participants” who actually carry out the practices being investigated are so small that it behooves the authors to show that their sample size is adequate for their results to be significant.

One example (among many): Of the 7,234 participants (from twelve countries), 249 (3.4%) said FGC occurs in their “community”, and of these (??), 18 said they intended to organize FGC for their daughter. It is preposterous to think that 18 respondents can lead to a significant finding.

Another example (from Discussion section): “The COVID-19 pandemic influenced participants’ decision to organize FGM/C, with 1 in 7 participants accelerating circumcision because of the pandemic.” But that statement is based on only 19 (14.6%) participants—not to mention that 6 (4.6%) planned to delay FGC and 1 (0.8%) planned to cancel.

*3. Have the authors made all data underlying the findings in their manuscript fully available? No

The supporting materials seem to be incomplete. In particular, the authors state in their discussion section that “Our study has showen [sic] the association between closure of schools due to the pandemic and decision to organize FGC/M sooner than planned.” Yet nowhere is there any mention of school closures in the survey questions or data description.

*4. Is the manuscript presented in an intelligible fashion and written in standard English? yes

The writing for the most part is fine, but there are many typos.

General:

FGC covers a wide spectrum of practices, from full infibulation to a mere symbolic prick or scraping. The authors narrow the definition from the source they themselves cite to “the partial or complete removal of the female genitalia...”

The authors seem to be trying to claim that human rights (in this case, girl’s rights) have been negatively impacted by COVID. But they cannot make that claim based on the data they present here.

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Reviewer #1: No

Reviewer #2: Yes: Mercedes Alarcon

Reviewer #3: No

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PONE-D-23-10482R1COVID-19 and Female Genital Mutilation/Cutting and Child Marriage: An online multi-country cross sectional surveyPLOS ONE

Dear Dr. Kpokiri,

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 18 2024 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,

Zeus Aranda, MSc MBA

Academic Editor

PLOS ONE

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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 #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 #2: Partly

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

Reviewer #2: 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 #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 #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 #2: Overall the appropiate changes were made , the limitations of the study are clear and well explained.

It would be helpful to explain that the FMG C and child marriage were optional in the survey and that the survey did not include questions about the type of COVID restrictions.

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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 #2: Yes: Mercedes Alarcon

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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.

COVID-19 and Female Genital Mutilation/Cutting and Child Marriage: An online multi-country cross sectional survey

PONE-D-23-10482R2

Dear Dr. Kpokiri,

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 will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, 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,

Zeus Aranda, MSc MBA

Academic Editor

PLOS ONE

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