A subnational socioeconomic assessment of family planning levels, projections, and disparities among married women of reproductive age in Cameroon

Raïssa Shiyghan Nsashiyi; Md Mizanur Rahman; Lawrence Monah Ndam; Masahiro Hashizume

doi:10.1371/journal.pone.0318650

Peer Review History

Original SubmissionFebruary 19, 2024
19 Feb 2024 Author Response https://doi.org/10.1371/journal.pone.0318650.r001
16 Oct 2024 Decision Letter - Yibeltal Alemu Bekele, Editor PONE-D-24-06584The Editor-in-Chief, PLOS ONE journal, A subnational socioeconomic assessment of family planning levels, projections, and disparities among married women of reproductive age in CameroonPLOS ONE Dear Dr. Nsashiyi, 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 Nov 30 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. 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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Please amend either the title on the online submission form (via Edit Submission) or the title in the manuscript so that they are identical. 3. 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 If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references.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 If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [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? 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 ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #2: Yes ****** 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: Yes Reviewer #2: Yes ****** 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 ****** 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: Please find my comments below: First of all, it is important to know which definition of unmet need used in the manuscript. Also, It is important to provide information on average marriage age, especially for women. In the line 96, the writing of the figure 1,5426 is not correct In the lines 102 and 103, the method can be used by woman or her husband/ partner Regarding the line 336 and next sentences It is very important to prioritize the poorer and less educated people. But simultaneously, country should develop programs for increasing the literacy level as a standing agenda and a cornerstone for development issues. The social policy and social security relevant organization need to develop the relevant programs. In the line 354 what is the meaning of positive trend. Does it mean the gap decrease or the figure increase. For me it is vague. In the line 366 In the text, more than 20 years old is a predictor for increasing contraceptive use. As a usual, with increasing the age and going to the older generation, contraceptive use may decrease. It is necessary to have a short explanation on it. In the line 376 and next sentences, uncovering disparities and its reasons will help policymakers to develop a plan toward SDG goals. It will show that different region in the country needs different approaches and intervention. In the conclusion, it is necessary to think about multi-sectoral cooperation for improvement of literacy rate, social support schemes, provision of services with subsidy, improvement of access ... Reviewer #2: There is no substantial comment to be forwarded, How ever, I recommend the abstract to be rewritten to give a brief and explained background information regarding the topic "interest socioeconomic assessment of family planning levels". Additionally, the conclusion section should be revised to make it focused on the major results. ****** 6. 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: Mohammad Eslami Reviewer #2: No ******** [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. Attachments Attachment Submitted filename: PONE-D-24-06584 MEslami 20240911.pdf https://doi.org/10.1371/journal.pone.0318650.r002
Revision 1
28 Oct 2024 Author Response Response to Reviewers ===================================================================== Journal Requirements: 1. When submitting your revision, we need you to address these additional requirements. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf Response to point 1: Thank you. The manuscript has been revised in line with the PLOS ONE's style requirements provided in the linked documents. 2. Please amend either the title on the online submission form (via Edit Submission) or the title in the manuscript so that they are identical. Response to point 2: Thank you. The title on the online submission form has been amended to be identical to the title in the manuscript. 3. 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. Response to point 3: Thank you. The reference list has been crosschecked and updated according to the specifications mentioned above. Three references have been added to the reference list to support revisions made, including some in line with some of the reviewers’ comments. These include; Citation [41] (Lines 356–359) • Reference: 41. Sultan S. The Effects of Education, Poverty, and Resources on Family Planning in Developing Countries. Clinics in Mother and Child Health. 2018;15. doi: 10.4172/2090-7214.1000289 • Rationale: To support revision made in response to Reviewer #1’s Comment 6 below. Citation [44] (Lines 394–397) • Reference: 44. Nimani TD, Tadese ZB, Tadese EE, et al. Trend, geographical distribution, and determinants of modern contraceptive use among married reproductive-age women, based on the 2000, 2005, 2011, and 2016 Ethiopian demographic and health survey. BMC women's health 2023;23(1):629. doi: 10.1186/s12905-023-02789-z • Rationale: To support revision made in response to Reviewer #1’s Comment 8 below. Citation [10] (Lines 70–71; 349–352) • Reference: 10. Nsashiyi RS, Rahman MM, Ndam LM, et al. Contraceptive use, unmet need, and demand satisfied for family planning across Cameroon: a subnational study including indirect effects of COVID-19 and armed conflict on projections. BMC Global and Public Health 2024;2(1):40. doi: 10.1186/s44263-024-00071-4 • Rationale: To insert a more relevant recently published article that aligns with the statements made. ===================================================================== Reviewer #1: Please find my comments below: Comment 1: First of all, it is important to know which definition of unmet need used in the manuscript. Response 1: Thank you for your feedback. We defined “Unmet need for modern methods is the percentage of women who are not currently using any method of contraception to prevent pregnancy but want to space or limit childbearing.” (Lines 105–107) The following statement has been added for clarity “...This indicator also includes women using traditional family planning methods, as they are considered to have an unmet need for more effective modern contraceptive methods. (Lines 107–109) Our definition was drawn from the DHS revised definition of unmet need (Bradley et al. (2012) [Citation number 29]: https://dhsprogram.com/pubs/pdf/AS25/AS25[12June2012].pdf), which also includes women who are using a traditional method of family planning. Comment 2: Also, It is important to provide information on average marriage age, especially for women. It is important to provide information on average marriage age, especially for women. Response 2: Thank you. Average marriage age has been added to the descriptive results (i.e., in Line 266–267) Comment 3: In the line 96, the writing of the figure 1,5426 is not correct Response 3: Thank you. The figure has been corrected to “15,426” (Line 99) Comment 4: In the lines 102 and 103, the method can be used by woman or her husband/ partner Response 4: Thank you. The definition has been revised to include husbands/partners (Line 104). Comment 5: There are something which not follow the main trend. Their should be considered in the discussion. There were some exceptions which was not addressed in the discussion so far. Response 5: Thank you for highlighting this. The unexpected findings/exceptions have been discussed thus (Lines 402–409); “Notably, the study shows unexpected lower rates of modern contraceptive use among women with higher compared to secondary education, in the richer compared to middle wealth quintile, and parity ≥6 compared to parity 4–6. Recognising the potential influence of study limitations, these findings suggest that women with higher educational attainment or from wealthier households may prioritise career or personal development over immediate reproductive needs. Also, women with more children may experience "fertility inertia" or less likely to seek contraception after achieving their desired family size.” Comment 6: Regarding the line 336 and next sentences It is very important to prioritize the poorer and less educated people. But simultaneously, country should develop programs for increasing the literacy level as a standing agenda and a cornerstone for development issues. The social policy and social security relevant organization need to develop the relevant programs. Response 6: Thank you for your suggestion. The statements have been revised (Lines 356–359) thus; “Simultaneously, the country should focus on increasing literacy and reducing poverty through its development initiatives as well as collaborative efforts with social services organisations, to enhance understanding and empower decision-making in family planning, particularly for these disadvantaged groups [41].” Comment 7: In the line 354 what is the meaning of positive trend. Does it mean the gap decrease or the figure increase. For me it is vague. Response 7: Thank you for pointing this out. ‘Positive’ and ‘Negative’ have been replaced with ‘Increasing’ and ‘Decreasing’. The sentence has been revised (Lines 376–378) thus; “More unclear are the education-related patterns of unmet need for modern methods, as trends across categories showed increasing levels in most regions (6 out of 10), and decreasing or steady in the rest. Comment 8: In the line 366 In the text, more than 20 years old is a predictor for increasing contraceptive use. As a usual, with increasing the age and going to the older generation, contraceptive use may decrease. It is necessary to have a short explanation on it. Response 8: Thank you. We have reinforced the discussions with your recommendation, thus (Lines 394–397); “Estimates showing that women aged 20 to 29 and 30 to 39 are at least twice more likely to use modern contraceptives compared to 15 to 19-year-olds aligns with literature, which indicates that contraceptive use trends increase with age until they begin to decline in older generations [23, 44].” Comment 9: In the line 376 and next sentences, uncovering disparities and its reasons will help policymakers to develop a plan toward SDG goals. It will show that different region in the country needs different approaches and intervention. Response 9: Thank you very much. Your suggestion has been incorporated, thus (Lines 422–424); “The findings should enable Cameroon to adopt varied approaches for family planning implementation and expansion, tailored to the disparities identified in each region.” Comment 10: In the conclusion, it is necessary to think about multi-sectoral cooperation for improvement of literacy rate, social support schemes, provision of services with subsidy, improvement of access ... Response 10: The conclusion has been reinforced with your suggestion, thus (Lines 448–451); “To effectively address these disparities, multi-sectoral cooperation is essential. This includes initiatives aimed at improving literacy rates, implementing social support schemes, providing subsidised services, and enhancing access to family planning resources.” ===================================================================== Reviewer #2: Comment: There is no substantial comment to be forwarded, How ever, I recommend the abstract to be rewritten to give a brief and explained background information regarding the topic "interest socioeconomic assessment of family planning levels". Additionally, the conclusion section should be revised to make it focused on the major results. Response: Thank you for your valuable feedback. The abstract background has been revised to demonstrate our "interest socioeconomic assessment of family planning levels" (Lines 27–31). ===================================================================== Attachments Attachment Submitted filename: Response to Reviewers.pdf https://doi.org/10.1371/journal.pone.0318650.r003
2 Dec 2024 Decision Letter - Yibeltal Alemu Bekele, Editor PONE-D-24-06584R1A subnational socioeconomic assessment of family planning levels, projections, and disparities among married women of reproductive age in CameroonPLOS ONE Dear Dr. Nsashiyi, 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 Jan 16 2025 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, Yibeltal Alemu Bekele, 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. [Note: HTML markup is below. Please do not edit.] 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) ******** 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 ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: 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: 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 ****** 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: Thanks. The comments were mostly addressed. I couldn't find the answer to one comment which was related to the average of marriage among the community. You already mentioned it was addressed but, I couldn't find it. ****** 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: Mohammad Eslami ******** [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. https://doi.org/10.1371/journal.pone.0318650.r004
Revision 2
27 Dec 2024 Author Response Response to Reviewers ===================================================================== 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. Response: Thank you for your guidance regarding the reference list. We have thoroughly cross-checked the reference list to ensure that it is complete and accurate. No new references were added; however, we have made several edits for consistency, including the addition of punctuation marks (full stops ‘.’), proper spacing, and the inclusion of ‘https://’ before the digital object identifier (DOI) for each article. We confirm that there are no retracted papers in our reference list. ===================================================================== Reviewer #1: Thanks. The comments were mostly addressed. I couldn't find the answer to one comment which was related to the average of marriage among the community. You already mentioned it was addressed but, I couldn't find it. Thank you for your comment. We have included the mean age of the respondents (i.e., married women of reproductive age) in the descriptive results, as the average age of marriage among the community was not captured in the dataset we utilized. Additionally, we were unable to locate reliable or scientifically sound sources that provide data on the average age of marriage in Cameroon. To ensure clarity, we have explicitly stated the average age of the respondents in the manuscript. Specifically, Lines 266-268 have been revised to read: “The descriptive results (Table 3) indicate that among the 1,513 respondents, the average age was 30.8 years (SD ±7.9), with a considerable proportion falling within the 20–29 (38.6%) and 30–39 (37.9%) age groups, while only 7.7% were aged 15–19.” We appreciate your valuable feedback and hope this revision addresses your concerns. ===================================================================== Attachments Attachment Submitted filename: Response_to_Reviewers_auresp_2.pdf https://doi.org/10.1371/journal.pone.0318650.r005
21 Jan 2025 Decision Letter - Yibeltal Alemu Bekele, Editor A subnational socioeconomic assessment of family planning levels, projections, and disparities among married women of reproductive age in Cameroon PONE-D-24-06584R2 Dear Dr. Raïssa Shiyghan Nsashiyi, 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, Yibeltal Alemu Bekele, MpH Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0318650.r006
Formally Accepted
Acceptance Letter - Yibeltal Alemu Bekele, Editor PONE-D-24-06584R2 PLOS ONE Dear Dr. Nsashiyi, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. 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. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Mr. Yibeltal Alemu Bekele Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0318650.r007

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