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Additional Editor Comments :

Data used were collected at baseline and 6 weeks after birth. Baseline can be during pregnancy to 6 weeks after birth, therefore duration from baseline to 6weeks time point can vary from zero days to more than 6 weeks (Fig 1). Is the exposure data (AN-IPV) collected at baseline and outcome data (EIBF and EBF) collected 6 weeks? How is the variability in this duration is accounted in the analysis?

1841 baby-mother pairs included in the analyses. That implies no twin births. But I noted having 28 twin births in results. Can EBF and/or EIBF differ between twins, if so how they were accounted in results?

Box with 1799 women in Fig1 is confusing as it says 2072 women were resulted from 1799 women. Consider removing that box (2024+273-177-35-13=2072).

Spellings:

table1, fig3, fig4 titles. Sex weeks to be changed to six weeks?

Fig4 axis title, should P-IPV to be changed to AN-IPV?.

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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

Reviewer #3: Partly

Reviewer #4: Yes

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

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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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.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: No

Reviewer #3: Yes

Reviewer #4: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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Reviewer #1: Great work overall, and it is good to see that a directed acyclic graph was used in this study. Please consider the following points regarding the results:

1. There may be a need to reorganize Table 1. Since the table spans multiple pages, breaking it down into groups would enhance comprehension and prevent the meaning from getting lost.

2. It is understandable that the models were assessed for goodness of fit, but did the authors evaluate whether the variables included were appropriate for the model? This could affect the findings, particularly if the models contain too few, too many, or irrelevant variables. It would be helpful to have the full model tables to see which variables were included.

3. If the authors included “any form of violence” and then also included physical and sexual violence separately in the same model, could that affect the outcome? It is unclear whether the authors considered this. “Any AN-IPV” was significant in the final model, but the separate violence categories (physical and sexual) were not; why? Would the authors consider a model with interaction terms? What other factors could be influencing these models? Should the authors have included only physical and sexual IPV rather than “any AN-IPV”? This distinction is important for public health actions and recommendations, as stating that “any AN-IPV affects EIBF” may be too vague.

Additionally, more rigorous analyses may be warranted

Reviewer #2: Here is a list of specific comments. Note: page numbering in reviews and comments is based on ruler applied in Editorial Manager-generated PDF. There is no line numbering.

1. Page 3, line 6, “impact”: Because the study is an observational study, I recommend avoiding words with causal interpretation such as “impact,” “effects,” etc. throughout the manuscript.

2. Page 3, line 14, “accounting for the hierarchical structure of the data”: I recommend being more specific about what hierarchical structure is accounted in the multilevel models.

3. Page 5, lines 2–3, “while some studies . . . ”: I recommend describing the direction, a negative or positive association, among references #22–28, as comparing to that in reference #21.

4. Page 7, lines 5–6, “a binary variable, . . . ”: Because EBF is defined as a proportion, I recommend providing additional information regarding how the binary EBF is defined (e.g., the proportion >0 vs 0).

5. Page 7, lines 16–18, “covariates included . . . ”: I recommend reminding readers that the manuscript assumes that both outcomes, EIBF and EBF, share the same DAG; i.e., the same minimally sufficient set of variables are used in both EIBF and EBF models.

6. Page 7, line 20, “these variables were grouped into five broad categories”: I recommend stating how many variables are inlcuded in the minimally sufficient set adnd adjusted in the models.

7. Page 8, line 3, “stratifier variable”: I recommend describing the enumeration areas as cluster variable and reserving stratifying variables for the AN-IPV types and urban/rural areas.

8. Page 8, lines 3–4, “cluster number . . . ”: I recommend revising “cluster number” as ‘cluster identification.’

9. Page 8, line 15, “homogeneity of variance”: Logistic regression does not require the homogeneity of variance assumption. I recommend removing it.

10. Page 8, lines 23–24, “model fit . . . ”: The variables included in the EIBF and EBF models are determined by the DAG. Therefore, there is no variable selection process in the analysis. I recommend clarifying the selection of the best-fitting model using DIC.

11. Page 8, line 26, “communities”: I recommend referring the clusters as the enumeration areas for consistency.

12. Page 8, lines 26–32, “three models . . . ”: I see the rationale of DIC now. However, because the confounders have been identified via the DAG, associations in Model 1 and Model 2 are assumed biased, provided that the DAG is accurate. I will emphasize again the clarification of model selection and sequential models.

13. Page 9, lines 12–13, “after applying sampling weights . . . ”: Please clarify in the manuscript the reason the weighted sample size, 1610, is smaller than 1841.

Reviewer #3: The authors used nationally representative data in Ethiopia to examine the association between intimate partner violence (IPV) and breastfeeding (BF). The results are reasonable, with two comments.

1. Why did the authors use iweight for descriptive statistics and pweight for regression models?

2. The authors acknowledged there might be under-reporting of IPV and over-reporting of BF. Instead of assuming the two reporting biases were independent, quantitative bias analyses are needed.

Reviewer #4: This manuscript examines the association between antenatal intimate partner violence (AN-IPV) and breastfeeding practices using nationally representative longitudinal data from the PMA-Ethiopia survey. The topic is highly relevant to maternal and child health in low-resource settings, and the authors address an important evidence gap in Ethiopia. The use of a longitudinal cohort, multilevel modeling, and theory-driven confounder selection strengthens the methodological rigor of the study.

The manuscript is well written, methodologically sound, and suitable for publication in PLOS ONE. However, several issues related to conceptual clarity, measurement, interpretation of findings, and presentation should be addressed to improve the scientific clarity and robustness of the paper.

Major Comments

1. Conceptual Framework and Mechanisms

The conceptual mechanisms linking IPV during pregnancy to breastfeeding outcomes are not sufficiently articulated. The introduction and discussion would benefit from a clearer theoretical explanation of how AN-IPV may differentially affect EIBF versus exclusive breastfeeding (EBF).

Recommendation:

Include a brief conceptual discussion outlining plausible biological (e.g., stress-related hormonal disruption), psychological (e.g., trauma, depression), and social (e.g., partner control, reduced support) pathways linking AN-IPV to breastfeeding practices.

2. Timing of Exposure and Outcome Measurement

Both exposure (AN-IPV) and outcomes (EIBF and EBF) were collected at the six-week postpartum interview. Although AN-IPV is defined as occurring during pregnancy, retrospective reporting at six weeks postpartum raises concerns about recall bias and temporal ambiguity.

Recommendation:

Clarify how AN-IPV questions were framed to ensure they referred strictly to the pregnancy period. Discuss potential recall bias and its likely impact on effect estimates more explicitly in the limitations section.

3. Interpretation of Null Findings for Exclusive Breastfeeding

The manuscript reports no statistically significant association between AN-IPV and EBF at six weeks postpartum, yet this finding is not sufficiently explored. Given that EBF is a key outcome, the lack of association warrants deeper interpretation.

Recommendation:

Expand the discussion to explore possible explanations for the null association, such as the short follow-up period, strong breastfeeding norms in Ethiopia, measurement using 24-hour recall, or insufficient statistical power for IPV sub-types.

4. Measurement of Intimate Partner Violence

The study excludes psychological/emotional IPV due to data limitations, which likely underestimates the true burden of AN-IPV and may bias associations toward the null.

Recommendation:

Strengthen the limitations section by explicitly discussing how exclusion of emotional IPV may affect prevalence estimates and observed associations.

5. Statistical Power and Subgroup Analyses

The prevalence of sexual and physical AN-IPV is relatively low, which may limit statistical power, particularly in stratified analyses.

Recommendation:

Acknowledge the potential for limited power to detect associations, especially in fully adjusted models for IPV sub-types.

Minor Comments

Length and Structure of Table 1

Table 1 is very detailed and may overwhelm readers.

Suggestion: Consider moving some variables to supplementary material or highlighting key predictors in the text.

Abstract Conclusion

The conclusion of the abstract slightly overgeneralizes the findings.

Suggestion: Rephrase to clearly distinguish findings for EIBF versus EBF.

Consistency in Terminology

Ensure consistent use of terms such as “AN-IPV,” “antenatal IPV,” and “IPV during pregnancy” throughout the manuscript.

Grammar and Formatting

Minor typographical and formatting inconsistencies appear in tables and headings.

Suggestion: A careful copy-edit is recommended prior to publication.

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what does this mean?). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

Reviewer #4: No

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Antenatal intimate partner violence and breastfeeding practices: Evidence from a national longitudinal study in Ethiopia

PONE-D-25-57004R1

Dear Dr. Azene,

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,

Ari Samaranayaka, PhD

Academic Editor

PLOS One

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer’s Responses to Questions

Comments to the Author

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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

Reviewer #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: 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.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: No

Reviewer #2: No

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

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: The authors have addressed all the comments that were identified by ne sufficiently. I recommend that the editors check for conformity with the journal style. Barring any journal requirement issues, the manuscript can be accepted for publication.

Reviewer #2: (No Response)

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what does this mean?). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.). 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 For information about this choice, including consent withdrawal, please see our For information about this choice, including consent withdrawal, please see our For information about this choice, including consent withdrawal, please see our Privacy Policy..-->

Reviewer #1: No

Reviewer #2: No

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