PONE-D-23-13119Factors associated with unintended pregnancy and contraceptive practices in justice-involved adolescent girls in Australia.PLOS ONE

Dear Dr. Smith,

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. While some of the reviewers were more positive, I am in agreement with the reviewers overall that substantial changes are required to render the manuscript acceptable for publication. Please attend to all of the points raised by the reviewers.

Please submit your revised manuscript by Aug 12 2023 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,

Andrea Knittel

Academic Editor

PLOS ONE

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2. 1) You indicated that you had ethical approval for your study. In your Methods section, please ensure you have also stated whether you obtained consent from parents or guardians of the minors included in the study or whether the research ethics committee or IRB specifically waived the need for their consent.

    2) Please provide additional information regarding the considerations  made for the prisoners included in this study. For instance, please discuss whether participants were able to opt out of the study and whether individuals who did not participate receive the same treatment offered to participants.

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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: Partly

Reviewer #2: Yes

Reviewer #3: Partly

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

Reviewer #1: I Don't Know

Reviewer #2: Yes

Reviewer #3: I Don't Know

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: Yes

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

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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: This is an important study that uses unique data from a vulnerable population in an ethical manner. Overall it is well written and the results are appropriately contextualized. My main suggestions are the following:

- In the abstract and throughout the main body of the manuscript, I recommend prioritizing the N instead of the %. This is because the total sample size is relatively small and close to 100. When is space to report both N and percentage, report both. If there's only space to report one number, I recommend reporting N.

- I've recommended the editors invite a statistical reviewer to evaluate the use of multivariate analyses in this study. I believe that the authors should detail exactly which independent variables were included in each model. In addition, I question the identification of independent variables using a p-value threshold instead of (for instance) a priori based on theoretical grounds.

Reviewer #2: The authors present a study examining factors associated with unintended pregnancy, non-contraceptive use and Long-Acting Reversible Contraception (LARC) in a sample of sexually active, justice-involved adolescent girls from Western Australia and Queensland. I though the authors did an excellent job outlining the information in a clear and succinct manner.

Comments

Introduction: The authors clearly described the background and significance of this issue, not only nationally (Australia), but also internationally. I was able to walk away with a clear understanding of the population (why aboriginal/strait islanders where used as the reference population), as well as, why LARC was the contraceptive method of interest.

Methods: The methods section was clear and is easily reproducible. The only suggestion I would offer is to more explicitly state the study design type.

Results: Minor style recommendation-I recommend reporting all data with consistent decimal points (i.e. data in tables rounded to 1 decimal place, data in text variable)

Discussion: This section appropriately addressed many of the questions that arose from the result section. I would have liked to see a little more discussion around the factors associated with LARC use, notably "being drunk at the last sexual encounter" and sexual orientation. Those results were surprising to me and contextualizing it in the discussion section would have been helpful.

Overall, I thought this study was well done and warrants acceptance.

Reviewer #3: Thank you for the opportunity to review this manuscript “Factors associated with unintended pregnancy and contraceptive practices in justice-involved adolescent girls in Australia.” This is an important topic and addresses issues of health inequities in an often overlooked population. The manuscript would benefit from revisions and clarifications. In particular, there is an unquestioned assumption that adolescents must be on LARCs to prevent unintended pregnancy, but there is some nuance there, rooted in colonial histories of oppression and eugenicist ideas of stratified reproduction, that should be thought through more (I’ve provided suggestions on where), and missing information about what happened to the unintended pregnancies. It is not simply the fact of unintended pregnancy that may be associated with certain negative outcomes, but whether people parent or not.

More detailed comments are below.

Page 2

Abstract

Line 33 and 44 and main text- recommend consistent language, as adolescent girls vs. young girls are both used here, and at other places you use adolescent women. Please choose one and use throughout.

Methods needs a little more detail as to what was done/study design, not just what database was used and the sampling, but type of study design and outcomes measured.

Line 33- comma after girls and before who

Lines 78-86. This discussion of LARC would benefit from being balanced by the critique of these campaigns to promote provider-controlled LARC methods in adolescents (and other groups) over other reversible methods. Please explain why you prioritize LARC as something that should be encouraged. While there has been an assumption that people, especially adolescents, should use these highly effective methods, this assumption has also been shown to be laden with pejorative judgements about whose reproductive capacities are more valued and whose should be suppressed—see for instance Gomez AM “Women or LARC first?” Perspect Sex Reprod Health. 2014.

Line 95 and 127- Please define reproductive coercion as many readers may not be familiar with the term. In addition, there are (at least) 2 levels of reproductive coercion- one at the partner level, and one at the systemic level with providers coercing patients into choosing certain methods; this latter point is relevant for and has been documented in the literature for LARC methods, and therefore needs some mention and teasing out.

Paragraph beginning line 99- Please provide some information on how many adolescent females are involved in the justice system.

139 This sentence would benefit from a little tweaking for clarity to sign post for readers that you are now shifting into describing what you are doing in the present study. A broad statement of the type of study design would be helpful

142-143- This kind of a statement is better in the discussion. In the intro, you can set this idea up earlier by noting that this is a gap in the literature.

155- please avoid the use of the term “offender” in favor of humanizing language.

For readers unfamiliar with the Australian juvenile carceral system and access to health care, it would be very helpful in the intro to provide some “setting” background on what the status of access to health care is like, and whether contraception access in custody is routine (perhaps it is in here and I missed it?). Relatedly, readers will want to know what LARC access and use among adolescents in Australia is like for context to the study population/research question.

Methods

Before describing the sampling, it would be helpful to explain what kind of data were collected—the fact that you interviewed participants via survey doesn’t come through until 183, and even then you assume readers know that this study involved surveying people (“the survey was delivered”) but you haven’t yet explained that the overall study design was a cross sectional survey. This would be helpful to clarify earlier on, and then you can get into the details of sampling, recruitment, survey design and administration.

156- comma after Islander girls. Also, how did you determine their identity category? Self identified?

215- Unintended pregnancy variable- did you collect data on what happened to those pregnancies? Abortion? Birth? Miscarriage? And if birth, parenting or adoption? This is important information for the context of the research questions you have set out to know, especially since you the frame the study so much in terms of the harms of unintended pregnancy. If this was not collected, then this does need justification. Otherwise, please report.

218-219- The list of what was included as a modern contraceptive method excludes some commonly used modern methods. Why does this not include contraceptive patch, contraceptive vaginal ring, injectable contraception, and IUDs?

In the outcomes in the abstract at least you report ‘contraceptive use,’ not just non-contraceptive use. Does contraceptive use include LARC? If not, then you should rename the category to be specific to what you have included.

222- The definition of what the authors are including as a long-acting reversible contraceptive is not standard. On lines 81-82, the authors DO use the standard definition, so it is confusing here that they have changed the categorization. LARCs include intrauterine devices and subdermal contraceptive implants. Injectable is typically not considered a LARC- if the authors are using a particular organization’s categorizations of LARCs that includes injectable, please cite it. Or if the authors have another compelling reason why they want to include injectable in this category of outcomes, then the category should be renamed to signal it is inclusive of injectable; otherwise, the authors would need to re-do analyses to exclude injectable from the LARC category.

223- does ‘implant’ here refer to subdermal contraceptive implants or other intrauterine implants?

Furthermore, why are copper IUDs not included? And recommend not referring to “Mirena” by its brand name, but rather hormonal or levonorgestrel released IUD (per WHO nomenclature guidance).

Results

266-307- This is a lot of text to describe what is in Table 1. Suggest streamlining so as to not duplicate too much what readers can learn from looking at Table 1.

347- not being drunk at last sexual encounter being associated with LARC use will need to be teased out in the discussion. Use of LARC (and any specific choice of method) depends on so many factors, and with LARC in particular it is highly dependent on structural factors of access. How would being drunk relate to whether a community provides youth access to LARC?

Discussion

The discussion would benefit from a greater consideration of issues of LARC access (as mentioned above) as one factor determining use of LARC, both in the broader discussion and in the limitations.

As with the introduction, a consideration of the nuance of LARC access in youth, without taking for granted the assumption that the goals is for more youths to use LARCs (see Gomez article). What about goals of reducing violence and other upstream factors as a takeaway from this study?

Also the issue of what happened to those unintended pregnancies must be addressed. If the authors did not collect this at all, this is a major limitation.

The discussion of the nuance of the categories unplanned/unintended is well done.

496-498- The authors could make a stronger conclusion oriented toward violence prevention and treatment for the sequellae, rather than focusing solely on the goal of increasing LARC use. The authors could be more specific about “further attention”—they have enough compelling data to call for action, policy and service recommendations rather than a generic “further attention.”

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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PONE-D-23-13119R1Factors associated with unintended pregnancy and contraceptive practices in justice-involved adolescent girls in Australia.PLOS ONE

Dear Dr. Smith,

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. I appreciate your responsiveness to the reviewer comments. I have identified a few minor issues that have arisen with the revision and have outlined those below.

Please submit your revised manuscript by Apr 19 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,

Andrea Knittel

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:

Several small issues have been introduced in the process of revision. I have outlined these here:

Line 101: IUD = Intrauterine device (not inter-uterine). Please ensure this is correct throughout.

Line 148: The revisions suggested that all instances of “young women” or other terms had been changed to “adolescent girls.” Consider also changing in this instance.

Line 158: Reproductive coercion would be more appropriately frame as gender neutral. Consider: “Reproductive coercion refers to where a person is exposed to behavior interfering with the ability to make autonomous decisions about reproductive health. This could involve…force a person to either terminate or keep a pregnancy against their wishes.” And so on.

Line 304: The definition of “modern” contraceptive methods remain odd. It seems a stretch to describe condoms as modern and the phrase “short and long-acting” is strange. Consider instead removing the modifier “modern” and just listing the options that were included in their entirety.

Table 1: Many of the labels are unclear. For example, presumably “forced or frightened to have sex” means that this was done to the participants, not that they engaged in this behavior. It is not clear what “Last penetrative sex with regular partner” means. Please review these descriptors to ensure that the tables can stand alone.

Line 501: This is now a run-on sentence. Please revise.

Line 581-582: This sentence seems to confuse LGBTQ+ identity with behavior. If prior literature focuses on behavior, consider clarifying this, or use the “identity/identify” language throughout.

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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.

Factors associated with unintended pregnancy and contraceptive practices in justice-involved adolescent girls in Australia.

PONE-D-23-13119R2

Dear Dr. Smith,

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,

Andrea Knittel

Academic Editor

PLOS ONE

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