PONE-D-24-05732Women's Experiences and Outcomes of Abortion Care in Sub-Saharan Countries: A Mixed Methods Systematic Review ProtocolPLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: Yes

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Reviewer #1: No

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 and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

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(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Title: Women's Experiences and Outcomes of Abortion Care in Sub-Saharan Countries:

A Mixed Methods Systematic Review Protocol

I have had the opportunity to review your protocol for the systematic review on "Women's Experiences and Outcomes of Abortion Care in Sub-Saharan Countries", and I would like to provide you with some suggestions for improvement:

The protocol's overall language quality is good; there are some grammatical errors throughout the entire protocol. Before the next submission, I recommend that the entire protocol be revised again.

1. The introduction should provide a clear rationale for conducting this systematic review. Why is understanding abortion care experiences and outcomes in Sub-Saharan countries important? Consider emphasizing the public health implications.

2. Clarify the research question: The research question should be clearly defined and specific. Make sure that it is focused on a particular aspect of women's experiences and outcomes of abortion care in Sub-Saharan countries.

2. Justify the choice of study designs: Provide a rationale for why you have chosen to include both qualitative and quantitative studies in your review. Explain how each type of study will contribute to answering your research question.

3. Define inclusion and exclusion criteria: Clearly outline the criteria that will be used to select studies for inclusion in the review. This will help ensure that the selection process is transparent and reproducible.

4. Consider potential biases: Discuss potential sources of bias in the included studies, such as publication bias or selection bias. Outline how you plan to address these biases in your review.

5. Quality Assessment: Address how heterogeneity in study quality will be handled.

6. Describe data extraction and synthesis methods: Provide details on how data will be extracted from the included studies and how it will be synthesized to answer the research question. This will help readers understand the analytical approach you plan to take. Consider using a standardized form. Describe the planned synthesis methods (qualitative, quantitative, or mixed methods). Will a meta-analysis be conducted?

7. Consider implications for policy and practice: Think about how the findings of your review could inform policy and practice in Sub-Saharan countries. Consider including a discussion of potential implications in your protocol.

Overall, your protocol is well-structured and provides a solid foundation for conducting a systematic review on this important topic. By addressing these suggestions, you can strengthen the rigor and relevance of your study.

Reviewer #2: General comments

The over all structure of the paper is good and it is well written according to the journal guideline.

Specific comments

1. Title- does experience and outcome are related? Why the researchers want to address both outcomes as the same time?

2. Abstract- this section missed the inclusion Criteria. What is the need of discussion in the protocol?

3. Review questions- what is the purpose of the second question? Does the researcher want to synthesis the tools used to assess the abortion care experience?

4. Inclusion and exclusion criteria- the authors states that they will use population, concept and context (PCC) as indicated in the JBI (line number 91). However, the JBI manual suggests that population phenomena of interest and context (PPC). How do you respond for these inconsistencies?

5. In the table1 what are abortion outcomes related to health care interventions?

6. In the inclusion and exclusion criteria what do you think if you indicate separately for quantitative and qualitative studies?

7. Lien150- the authors indicate that they will use convergent approach. If so, what about the transformation of data from quantitative to qualitative (qualitized data)? or vice versa?

Reviewer #3: Overall Assessment:

The manuscript presents a well-structured and important systematic review protocol aimed at synthesizing evidence on women's abortion care experiences and outcomes in sub-Saharan Africa. The topic is highly relevant given the public health implications of abortion care in this region, where legal, cultural, and healthcare barriers significantly affect women's experiences and outcomes. The approach to integrating both qualitative and quantitative data is commendable, as it promises a comprehensive understanding of the multifactorial challenges faced by women. However, several areas could benefit from further elaboration and clarification to strengthen the protocol's robustness and potential impact.

Here are my suggestions for improving your manuscript:

1.Introduction: Consider providing a stronger justification for selecting studies published from 2010 onwards. While recent developments in abortion care practices and legal changes likely inform this choice, explicitly stating this rationale would help clarify the scope of the review. Additionally, expanding on the existing gaps in the literature regarding women's abortion care experiences and outcomes in Sub-Saharan Africa would strengthen the argument for why this systematic review is necessary.

2.Methods: Your search strategy is thorough, but it would be beneficial to address how you plan to manage potential language biases due to the exclusion of non-English studies. In the data synthesis section, please provide more detail on how you intend to integrate qualitative and quantitative data using the convergent, segregated synthesis approach. This will clarify the methodology for readers. Additionally, while the use of JBI checklists for quality assessment is appropriate, it would be helpful to explain how the quality assessment results will influence the synthesis of findings. Will studies of lower quality be weighted differently or potentially excluded from the final analysis?

3.Discussion: While you have effectively highlighted the importance of understanding abortion care experiences and outcomes, I recommend placing more emphasis on how your findings could directly influence abortion care policies and practices in Sub-Saharan Africa. Furthermore, consider outlining specific future research questions or areas that might arise from this systematic review to guide further studies in this critical area.

4.Ethical Considerations: Although you correctly state that ethical approval is waived due to the use of published data, it may be beneficial to briefly discuss the ethical implications of interpreting and using sensitive data related to abortion experiences. This consideration could add depth to your ethical discussion.

5.Author Contributions: It might be useful to specify the exact contributions of each author to enhance transparency.

6.Formatting and Clarity: Finally, ensure consistency in terminology throughout the manuscript, particularly with terms such as "woman-centred" versus "person-centred." This will enhance the clarity and professionalism of your manuscript.

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Reviewer #1: Yes: Mesfin Abebe

Reviewer #2: No

Reviewer #3: No

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Women's Experiences and Outcomes of Abortion Care in Sub-Saharan Countries: A Mixed Methods Systematic Review Protocol

PONE-D-24-05732R1

Dear Dr. Wakgari,

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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Staff Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Yes

Reviewer #3: Yes

**********

2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: Yes

Reviewer #3: Yes

**********

3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: Yes

Reviewer #3: Yes

**********

4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. 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

**********

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 and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The author has thoroughly addressed all of my previous comments. They have carefully considered each point I raised and provided comprehensive responses or made the necessary revisions to the manuscript. The changes made reflect a clear understanding of the feedback provided, and the author has effectively incorporated these suggestions to enhance the overall quality and clarity of the work.

Reviewer #3: All the comments and suggestions I mentioned during the review is addressed by Authors. I have no further questions or comments for them.

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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: Yes: Mesfin Abebe

Reviewer #3: No

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