Post-abortion contraceptive use among currently married women in India: New evidence from National Family Health Survey 2019–2021 (NFHS-5)

Joemet Jose; Ajit Kumar Kannaujiya; Kaushalendra Kumar; Lotus McDougal; Katherine Hay; Abhishek Singh

doi:10.1371/journal.pone.0322784

Peer Review History

Original SubmissionMarch 21, 2024
21 Mar 2024 Author Response https://doi.org/10.1371/journal.pone.0322784.r001
18 Mar 2025 Decision Letter - Jayanta Bora, Editor PONE-D-24-11169Post-abortion contraceptive use among currently married women in India: new evidence from National Family Health Survey 2019-2021 (NFHS-5)PLOS ONE Dear Dr. Abhishek Singh, 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 May 01 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. 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Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes 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: Overall, this study makes a valuable contribution to understanding post-abortion contraceptive use in India. It is highly relevant for policy-making but would benefit from the below suggested improvements. Comments for the Author 1. Abstract: If space permits, including a brief mention of the sample size and statistical methods used in the abstract would enhance the clarity for a broader audience. 2. Some abbreviations like LARC and SARC are not clearly defined when first introduced. Clarifying these would improve accessibility for the reader. 3. The article is well-written but some sections could be trimmed, especially repeated information on the importance of post-abortion contraceptive use. 4. In the Indian context, abortion is a highly sensitive issue, and women may be reluctant to report such incidents. This could result in underreporting of abortions in the reproductive calendar data which may result in biased association between factors affecting post abortion contraceptive use. How have you tackled this problem. 5. While the study is targeted at a specialist audience, a sentence or two simplifying complex terms would make it more accessible. For example terms like "Inverse Mills Ratio" (IMR) may not be familiar to all readers. Consider a brief explanation on the terms used wherever applicable. 6. It would help to briefly explain what is reproductive calendar data and how is it used in the analysis of this manuscript for those who are unfamiliar with it. 7. Attention to grammar, phrasing, and consistency in terminology will also contribute to a more polished and professional presentation of the research work. There are a few minor grammatical issues and typographical errors in the manuscript. Examples. § "These large increase in post-abortion contraceptive use in India since 2005-06..." can be corrected to "This large increase in post-abortion contraceptive use in India since 2005-06..." § "with the rest was completed after the COVID-19 related lockdowns were lifted..."can be corrected to "with the rest completed after the COVID-19 related lockdowns were lifted..." § "In 2019-21, 13% of women using PPIUCD received compensation." Can be corrected to "In 2019-21, 13% of women who used PPIUCD received compensation." § "The manuscript focuses on the important role media plays in improving contraceptive use." can be corrected to "The manuscript focuses on the important role that media plays in improving contraceptive use." § "Despite these efforts, the overall gain in post abortion family planning and the mix of methods promoted through these guidelines is not reflected..." can be corrected to "Despite these efforts, the overall gain in post-abortion family planning and the mix of methods promoted through these guidelines are not reflected...". Reviewer #2: The study highlights the importance of integrating family planning into abortion care.The use of multinomial probit regression analysis is appropriate for examining factors associated with contraceptive use. A brief mention of specific policy recommendations could make the findings more actionable. ****** 6. 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Revision 1
25 Mar 2025 Author Response Dated: March 24, 2025 To Dr. Jayanta Kumar Bora Academic Editor PLOS ONE Sub: Point-by-point reply to reviewer’s comments Dear Dr. Bora Thank you so much for considering our paper for possible publication in PLOS ONE. We are grateful to you for sharing the comments of reviewer with us. We have made maximum use of the comments to improve our paper. Please find below our point-by-point reply to the reviewer’s comments. I hope that you will find the revised paper suitable for publication in PLOS ONE. We will be happy to provide more information if needed. Yours Sincerely Authors Response to reviewer 1 Comment 1: Abstract: If space permits, including a brief mention of the sample size and statistical methods used in the abstract would enhance the clarity for a broader audience. Response: Thank you for your valuable suggestion. We have revised the abstract to include details on the sample size and statistical methods used in our study. Specifically, we now mention that our analyses are based on a weighted sample of 5,103 women from NFHS-5 and 5,473 women from NFHS-4. Additionally, we have specified that a two-stage estimation procedure using the Inverse Mills Ratio (IMR) framework was employed to address potential biases in abortion reporting. In the second stage, a multinomial probit regression model was used to examine factors associated with post-abortion contraceptive use. Comment 2: Some abbreviations like LARC and SARC are not clearly defined when first introduced. Clarifying these would improve accessibility for the reader. Response: Thank you for your helpful suggestion. We have revised the manuscript to ensure that abbreviations such as LARC (long-acting reversible contraception) and SARC (short-acting reversible contraception) are clearly defined when first introduced. This can be seen under the Outcome Variable section in the Methods. We now define LARC as long-term, easily reversible contraceptive methods and SARC as methods that require regular use or application and are easily reversible. Comment 3: The article is well-written but some sections could be trimmed, especially repeated information on the importance of post-abortion contraceptive use. Response: Thank you for your insightful suggestion. We have carefully revised the manuscript to remove any redundant information, particularly in sections discussing the importance of post-abortion contraceptive use. Comment 4: In the Indian context, abortion is a highly sensitive issue, and women may be reluctant to report such incidents. This could result in underreporting of abortions in the reproductive calendar data which may result in biased association between factors affecting post abortion contraceptive use. How have you tackled this problem? Response: Thank you for your thoughtful comment. We agree that abortion is a very sensitive issue in India, leading to potential underreporting in surveys. To address this, we have adopted a two-stage estimation procedure using the Inverse Mills Ratio (IMR) framework proposed by James Heckman. In the first stage, we used a probit regression model to estimate the likelihood of abortion, incorporating several explanatory variables such as previous pregnancy outcomes, desired fertility, age at marriage, education, household type, wealth quintiles, caste, residence, and religion. The IMR derived from this model captures potential selection bias in abortion reporting. Following this, we included the IMR as an independent variable in our multinomial probit regression model, which examines factors associated with post-abortion contraceptive use. This helps correct the potential biases from underreporting of abortions and ensures more reliable estimates. We have mentioned this in detail under the statistical analysis section of the manuscript. Comment 5: While the study is targeted at a specialist audience, a sentence or two simplifying complex terms would make it more accessible. For example, terms like "Inverse Mills Ratio" (IMR) may not be familiar to all readers. Consider a brief explanation on the terms used wherever applicable. Response: Thank you for your suggestion. We have now included a brief explanation of IMR in the Statistical analysis section. Specifically, we clarify that IMR is a correction factor used in regression models to account for selection bias, ensuring more reliable estimates when certain outcomes, such as abortion reporting, may be systematically underreported. Comment 6: It would help to briefly explain what is reproductive calendar data and how is it used in the analysis of this manuscript for those who are unfamiliar with it. Response: We have already defined reproductive calendar data in the manuscript. However, to improve clarity, we have added additional information and repositioned it earlier in the text. Comment 7: Attention to grammar, phrasing, and consistency in terminology will also contribute to a more polished and professional presentation of the research work. There are a few minor grammatical issues and typographical errors in the manuscript. Examples. § "These large increase in post-abortion contraceptive use in India since 2005-06..." can be corrected to "This large increase in post-abortion contraceptive use in India since 2005-06..." § "with the rest was completed after the COVID-19 related lockdowns were lifted..."can be corrected to "with the rest completed after the COVID-19 related lockdowns were lifted..." § "In 2019-21, 13% of women using PPIUCD received compensation." Can be corrected to "In 2019-21, 13% of women who used PPIUCD received compensation." § "The manuscript focuses on the important role media plays in improving contraceptive use." can be corrected to "The manuscript focuses on the important role that media plays in improving contraceptive use.” § "Despite these efforts, the overall gain in post abortion family planning and the mix of methods promoted through these guidelines is not reflected..." can be corrected to "Despite these efforts, the overall gain in post-abortion family planning and the mix of methods promoted through these guidelines are not reflected...". Response: Thank you for your detailed feedback. We have carefully reviewed the manuscript and made the necessary grammatical and typographical corrections to improve clarity, and consistency. We have revised the sentences you highlighted to ensure proper phrasing and grammatical accuracy. Additionally, we have conducted a thorough proofreading of the entire manuscript to address any other minor inconsistencies. Response to reviewer 2 Comment: The study highlights the importance of integrating family planning into abortion care. The use of multinomial probit regression analysis is appropriate for examining factors associated with contraceptive use. A brief mention of specific policy recommendations could make the findings more actionable. Response: Thank you for your valuable feedback. We have incorporated specific policy recommendations to make the findings more actionable. These include strengthening contraceptive counselling and expanding the availability of a wider range of contraceptive methods. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0322784.r003
28 Mar 2025 Decision Letter - Jayanta Bora, Editor Post-abortion contraceptive use among currently married women in India: new evidence from National Family Health Survey 2019-2021 (NFHS-5) PONE-D-24-11169R1 Dear Dr. Abhishek Singh, 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, Dr. Jayanta Kumar Bora Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0322784.r004
Formally Accepted
Acceptance Letter - Jayanta Bora, Editor PONE-D-24-11169R1 PLOS ONE Dear Dr. Singh, 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 You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days 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 Dr. Jayanta Kumar Bora Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0322784.r005

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