Rural-urban disparity in induced abortion in Ghana: A multivariate non-linear decomposition analysis of the Ghana Maternal Health Survey

Isaac Yeboah; Martin Wiredu Agyekum; Jerry John Ouner; Duah Dwomoh; Desmond Klu; Mary Naana Essiaw; Andrew Kweku Conduah; Sarah Asaah Owusu-Kwankye

doi:10.1371/journal.pone.0334024

Peer Review History

Original SubmissionDecember 28, 2024
12 May 2025 Decision Letter - Margubur Rahaman, Editor Dear Dr. Owusu-Kwankye, 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 Jun 26 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. 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'. 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Additional Editor Comments : The reviewers have highlighted several comments and suggestions which will assist to improve your scientific work. Kindly assure all POLS ONE guidelines during the revision submission. [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: No ******** 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 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: No ****** Reviewer #1: Thank you so much for providing me the opportunity to review the manuscript entitled "Rural-urban disparity in induced abortion in Ghana: a multivariate non-linear decomposition analysis of Ghana Maternal Health Survey". The manuscript meets all the scientific standards necessary to be published. However, the paper has some minor flaws which need to be addressed before it is suitable for publication. 1. In the abstract section, the same phrase has been repeated. Kindly remove the repeated one. 2. In the multivariate decomposition table, there is no hyphen between the lower and upper limits of CI. Kindly rectify the same. 3. There are a number of variables with missing responses. But you have not mentioned whether you have accommodated missing responses or excluded the same. So, address the same in your methodology section in nutshell. 4. You have put forth an insightful implication of Social Learning Theory. But you have not mentioned is there any specific model which you have used for executing the role of the aforementioned theory on rural urban divide in induced abortion. Kindly elaborate in your methodology section. 5. You have mentioned that you have chosen potential confounders based on prior literature although there is no citation for the same. Please make sure proper citation of the previous studies. 6. Please revise the Table 1 as there is no data for the variable called ‘Knowledge of ovulation’. It seems like you have overlooked the same. If that is not the case please make sure to add a note for the same. 7. Please try to stick on same categories of the variables throughout your writing. For instance, somewhere you have used mathematical sign for parity (6+) nevertheless have used text for the same (6 or more). Reviewer #2: Introduction The author wrote on important topic. However, he needs to give clue about induced abortion. Introduction is better to be started with main issue. What is abortion? What is induced abortion? what are major classification of induced abortion like safe or unsafe? What are the positive or negative sides of induced abortion? Thus, your introduction needs re-structuring. Discussion was poorly written. It needs improvement. The given justification needs more specific and be clear. Conclusions This part also needs more specific and to the point. It seems some conclusions are out of the research findings. ****** 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: Puja Das 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: Review Comments_Plos.docx Attachment Submitted filename: PONE-D-24-59727 (1).pdf https://doi.org/10.1371/journal.pone.0334024.r001
Revision 1
26 May 2025 Author Response Dear Editor, We are very pleased to be offered the opportunity to revise this manuscript. We have responded to the various comments by reviewers below. Reviewer #1: Thank you so much for providing me the opportunity to review the manuscript entitled "Rural-urban disparity in induced abortion in Ghana: a multivariate non-linear decomposition analysis of Ghana Maternal Health Survey". The manuscript meets all the scientific standards necessary to be published. However, the paper has some minor flaws which need to be addressed before it is suitable for publication. 1. In the abstract section, the same phrase has been repeated. Kindly remove the repeated one. Response: The sentence ‘The results were presented using coefficients and percentages’ appeared twice in the abstract section. One has been removed from the abstract section. Thank you. 2. In the multivariate decomposition table, there is no hyphen between the lower and upper limits of CI. Kindly rectify the same. Response: Thank you for the observation. We found that in the multivariable regression table, there was no hyphen for the age category of the Rural aOR, specifically for those aged 25-34 years. This has been corrected. However, we didn’t present 95%CI for the multivariate decomposition table. Thank you. 3. There are a number of variables with missing responses. But you have not mentioned whether you have accommodated missing responses or excluded the same. So, address the same in your methodology section in nutshell. Response: Thank you for this observation. Sample sizes differ between models due to missing data on included variables. All analysis excluded missing responses and was conducted using Stata version 17.1. This has been incorporated in the methodology section (statistical analyses). Thank you. 4. You have put forth an insightful implication of Social Learning Theory. But you have not mentioned is there any specific model which you have used for executing the role of the aforementioned theory on rural urban divide in induced abortion. Kindly elaborate in your methodology section. Response: Performing analysis based on place of residence is underpinned by the social learning behaviour theory that posits that the environment is a major force in human behavior in that human behavior is influenced by observation, modeling, and imitations. Hence, the segregation of the analysis by place of residence is examine the extent of difference in human behaviour (induced abortion). This has been added to the methods section, specifically statistical analyses. 5. You have mentioned that you have chosen potential confounders based on prior literature although there is no citation for the same. Please make sure proper citation of the previous studies. Response: Thank you for this observation. At the ‘potential confounders’ section we have included all the proper citation in previous studies. Then include [5,12,13,15,18,20-25, 30]. Thank you. 6. Please revise the Table 1 as there is no data for the variable called ‘Knowledge of ovulation’. It seems like you have overlooked the same. If that is not the case please make sure to add a note for the same. Response: This was an oversight. We have provided data for the cross tabulation between ‘induced abortion’ and ‘knowledge of ovulation’. See Table 1. 7. Please try to stick on same categories of the variables throughout your writing. For instance, somewhere you have used mathematical sign for parity (6+) nevertheless have used text for the same (6 or more). Response: Thank you for this observation. For the purposes of uniformity and clarity we used the text ‘6 or more’ for parity throughout the manuscript. Thank you. Reviewer #2: Introduction The author wrote on important topic. However, he needs to give clue about induced abortion. Introduction is better to be started with main issue. What is abortion? What is induced abortion? what are major classification of induced abortion like safe or unsafe? What are the positive or negative sides of induced abortion? Thus, your introduction needs re-structuring. Response: There is a complete overhaul and restructure of the introduction of the manuscript. The new structure of the introduction follows the funnel approach suggested by the reviewer. Thank you. Kindly see the introduction section. Discussion was poorly written. It needs improvement. The given justification needs more specific and be clear. Response: All authors have taken a second look at the discussion and revised it accordingly. Conclusions This part also needs more specific and to the point. It seems some conclusions are out of the research findings. Response: We have re-read the conclusion and made the necessary conclusion. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0334024.r002
23 Sep 2025 Decision Letter - Margubur Rahaman, Editor Rural-urban disparity in induced abortion in Ghana: a multivariate non-linear decomposition analysis of the Ghana Maternal Health Survey PONE-D-24-59727R1 Dear Dr. Owusu-Kwankye, 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. For questions related to billing, please contact billing support . 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, Margubur Rahaman, Ph.D. Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #1: (No Response) ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> 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 Reviewer #1: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes ****** Reviewer #1: (No Response) ****** 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: Puja Das ******** https://doi.org/10.1371/journal.pone.0334024.r003
Formally Accepted
Acceptance Letter - Margubur Rahaman, Editor PONE-D-24-59727R1 PLOS ONE Dear Dr. Owusu-Kwankye, 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. You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing. 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. Margubur Rahaman Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0334024.r004

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