Dear Dr. Kayiga,

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Kind regards,

Adnan Ahmad Khan, MBBS, MS.

Academic Editor

PLOS ONE

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Additional Editor Comments:

Thank you for submitting this study which addresses an important knowledge gap. Overall the study is well conducted and analyzed. There are the following minor revisions that may be considered.

1. While the overall manuscript is well written there are typos and some logical flow errors. Example dare instead of dire on line 54, additional word "yet" on line 70 etc. Please run word editor to ensure better readability

2. Interviews were conducted with only English speakers. This may have introduced bias towards higher educated or better socio-economic couples. Please address this in limitations including how this may impact the interpretation of your results

3. Since both husband and wife were interviewed, it would be interesting to see how their perceptions were similar and different and on what issues

Reviewer 1:

I commend the authors’ efforts in trying to fill an important gap in research and share such important findings. After reviewing the manuscript, here are some important points that the authors should consider:

• This sentence needs revision as unintended pregnancies are not necessarily unwanted pregnancies. They are unplanned. This means the pregnancies were not intended at the time of conception, regardless of whether they were unwanted or mistimed. This argument has evolved over time. Use updated articles.

• The argument on not well-documented reasons should be reviewed - “Despite proven effectiveness and safety of intrauterine contraception yet with a failure rate of less than one percent [14], uptake among Ugandan women has stagnated below two percent among married and 15% among sexually active unmarried women [15] for reasons that may not be well documented”. A quick Google search reflects otherwise (https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-022-01856-1; https://pmc.ncbi.nlm.nih.gov/articles/PMC10022157/)

• The paragraphs after lines 72 and 73 are confusing. The previous argument was that there may not be well documented reasons for the stagnation in the uptake of intrauterine conception among Ugandan women. However, subsequent arguments in the following paragraphs stated otherwise. I think these paragraphs should be revised to reflect exactly what the authors are trying to present in the introduction.

• I noticed that many of the references cited in the manuscript are somewhat dated. While these foundational works are undoubtedly valuable, it is also essential to incorporate more recent research to provide a comprehensive and current perspective on the topic. I recommend updating the references with more recent studies that have built upon or expanded the concepts discussed in the older articles.

• “Using purposive sampling with maximal variation, fifteen women and their partners aged between 18 and 49 years were invited to participate in the study at five public facilities in central Uganda.” What does maximal variation mean? I appreciate the descriptive details of the facilities, but I do not see the relevance in the study. This may be useful for other reports on the larger RCT study. Could you share the inclusion criteria to further highlight the level of variation?

• It was stated that the sample size was influenced by assumed saturation. Could this be clarified? Could the authors elaborate on what influenced the sample size?

• Despite the subtitle, participant recruitment details were not adequately presented in the manuscript. How were participants recruited? For the few details that were included, there was no reference to whether participants had previously consented to being contacted before contact details were retrieved from the database.

• “Fifteen in-depth interviews were conducted in English or Luganda by two interviewers and two note takers with prior experience in qualitative inquiry”. I appreciate the use of either English or Luganda to enhance quality data. Could you share why these options were presented? How did the subsequent translation of documents from one language to another impact data and its analysis? How did you mitigate the loss of the meaning of ideas during translation?

• I’m curious to know the influence of the socio-demographic details such as age and education on participants’ decisions.

• I appreciate that the analysis and the codebook development were adequately presented - showing how the codebook (subthemes and themes) was developed gives credence to this qualitative work.

• The verbatim quotes under cultural beliefs on IUDs do not necessarily support the arguments in that theme. Some of the quotes are more like responses to barriers that were presented to them, rather than the barriers that were shared by the participants.

• Review statement – “We used a semi-structured interview guide to collect information on participants’ sociodemographic characteristics, and the various barriers and motivators in the utilization of the IUDs”. I suggest overall proofreading and manuscript editing.

• A more detailed conclusion should be considered.

• Overall, the authors have presented important findings that will contribute to ongoing arguments on postabortion intrauterine contraception in Uganda and the global context if the manuscript is reviewed adequately before publication.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: N/A

Reviewer #2: Yes

**********

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

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

**********

Reviewer #1:  I commend the authors’ efforts in trying to fill an important gap in research and share such important findings. After reviewing the manuscript, here are some important points that the authors should consider:

• This sentence needs revision as unintended pregnancies are not necessarily unwanted pregnancies. They are unplanned. This means the pregnancies were not intended at the time of conception, regardless of whether they were unwanted or mistimed. This argument has evolved over time. Use updated articles.

• The argument on not well-documented reasons should be reviewed - “Despite proven effectiveness and safety of intrauterine contraception yet with a failure rate of less than one percent [14], uptake among Ugandan women has stagnated below two percent among married and 15% among sexually active unmarried women [15] for reasons that may not be well documented”. A quick Google search reflects otherwise (https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-022-01856-1; https://pmc.ncbi.nlm.nih.gov/articles/PMC10022157/)

• The paragraphs after lines 72 and 73 are confusing. The previous argument was that there may not be well documented reasons for the stagnation in the uptake of intrauterine conception among Ugandan women. However, subsequent arguments in the following paragraphs stated otherwise. I think these paragraphs should be revised to reflect exactly what the authors are trying to present in the introduction.

• I noticed that many of the references cited in the manuscript are somewhat dated. While these foundational works are undoubtedly valuable, it is also essential to incorporate more recent research to provide a comprehensive and current perspective on the topic. I recommend updating the references with more recent studies that have built upon or expanded the concepts discussed in the older articles.

• “Using purposive sampling with maximal variation, fifteen women and their partners aged between 18 and 49 years were invited to participate in the study at five public facilities in central Uganda.” What does maximal variation mean? I appreciate the descriptive details of the facilities, but I do not see the relevance in the study. This may be useful for other reports on the larger RCT study. Could you share the inclusion criteria to further highlight the level of variation?

• It was stated that the sample size was influenced by assumed saturation. Could this be clarified? Could the authors elaborate on what influenced the sample size?

• Despite the subtitle, participant recruitment details were not adequately presented in the manuscript. How were participants recruited? For the few details that were included, there was no reference to whether participants had previously consented to being contacted before contact details were retrieved from the database.

• “Fifteen in-depth interviews were conducted in English or Luganda by two interviewers and two note takers with prior experience in qualitative inquiry”. I appreciate the use of either English or Luganda to enhance quality data. Could you share why these options were presented? How did the subsequent translation of documents from one language to another impact data and its analysis? How did you mitigate the loss of the meaning of ideas during translation?

• I’m curious to know the influence of the socio-demographic details such as age and education on participants’ decisions.

• I appreciate that the analysis and the codebook development were adequately presented - showing how the codebook (subthemes and themes) was developed gives credence to this qualitative work.

• The verbatim quotes under cultural beliefs on IUDs do not necessarily support the arguments in that theme. Some of the quotes are more like responses to barriers that were presented to them, rather than the barriers that were shared by the participants.

• Review statement – “We used a semi-structured interview guide to collect information on participants’ sociodemographic characteristics, and the various barriers and motivators in the utilization of the IUDs”. I suggest overall proofreading and manuscript editing.

• A more detailed conclusion should be considered.

• Overall, the authors have presented important findings that will contribute to ongoing arguments on postabortion intrauterine contraception in Uganda and the global context if the manuscript is reviewed adequately before publication.

Reviewer #2:  The manuscript is well written and the research is conducted accordingly with methodological rigor.

There is no research or evidence of publication ethical issues in the this manuscript to the best of my understanding.

**********

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Reviewer #1: No

Reviewer #2: No

**********

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Attachments

Attachment

Submitted filename: Reviewers Comment PONE.docx

Attachment

Submitted filename: REVIEWED PONE-D-24-58782-.pdf

Perceptions of Women and their Partners on Postabortion Intrauterine Contraception: A Qualitative study in central Uganda

PONE-D-24-58782R1

Dear Dr. Kayiga

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.

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Kind regards,

Adnan Ahmad Khan, MBBS, MS.

Academic Editor

PLOS ONE

Reviewers' comments: