-->PONE-D-24-39098-->-->A cross-sectional prevalence study demonstrating a high uptake of postpartum family planning in a high risk setting in South Africa.-->-->PLOS ONE

Dear Dr. Sproul,

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.

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ACADEMIC EDITOR:  -->-->In addition to addressing the comments of the reviewers, authors should address the following concerns-->-->1.Title: Authors should remove the academic qualifications from the authors' list The title needs review. "A cross-sectional prevalence study demonstrating a high uptake of postpartum family planning in a high risk setting in South Africa." what "high risk" are the authors referring to? HIV prevalence? poor contraceptive uptake? etc. I suggest: "Prevalence and sociodemographic risk and morbidities associated with contraceptive uptake among postpartum women at ...... A cross-sectional study". This is a suggestion that can be reviewed by the authors.-->-->2.Authors should use continuous number line when submitting for efficient review-->-->3. Authors should read through the authors guideline and adhere strictly to it. -->-->4. Authors should add more numbers to the statistical result of the abstract.-->-->5.Please remove the Table in the introduction-->-->6.The statistical analysis did not describe a rigorous statistical analysis that is of quality for publishing in Plos one. I strongly recommend that authors should conduct bivariate analysis and if possible appropriate regression modelling to before the manuscript with be of high quality that can be published in PLOS ONE. The sample size is adequate for useful conclusion from the study-->-->7. Authors stated .".....standard deviation (SD), and range for continuous variables if normally distributed" What about if the continuous variable was not normally distributed?-->-->8.In the Result section, authors stated "Over a period of seven months 1066 participants were recruited for this study and had a recorded family planning method of their choice."  From the methodology section, it appears that the authors described retrospective chart review of routinely collected data. Please authors should be explicit about what study was conducted. was it a retrospective or prospective study?-->-->9Table 1 is not looking "professionsl" For example: "Delivery Characteristics" lumped many unrelated categories. One of the variables in that category is mode of delivery that can be vaginal delivery, operative vaginal delivery or caesarean section. Birth outcome such as live birth, fresh still birth, early neonatal death etc may be another category etc,-->-->10. This study seems to be among postpartum women. When after delivery was the interview conducted.? If it was anytime post partum. It will be good to know how soon after delivery that women presented for family planning at the hospitals. -->-->11. Table 2.  gravidity and parity are not likely to be normally distributed. Thus median and IQR may be more appropriate. Please check-->-->12.Disucssion: Authors to cite relevant literatures as required-->-->13. Please ensure that DMPA had been previously defined in the manuscript-->-->14. Are there any historical and structural issues that influences the contraceptive uptake pattern? . -->-->15, Social cultural and economic determinants of health is a very important issue  in South Africa. However, authors did not describe the ethnic characteristics of the studied participants. Occupation and income of the participants are also important information to provide. -->-->16. If the prevalence is so high, is it possible to collect further data for more months to assist to obtain more participants that will not take the contraceptive for easy comparative cross-sectional study?-->-->17. What are the reasons for the comparatively high contraceptive uptake in this population as compared with other south African and global studies?-->-->18. Authors stated "There is also a theoretical risk that high dose progesterone exposure may impact the development of the infant brain. Authors should cite appropriate reference for this statement.-->--> -->-->Please ensure that your decision is justified on PLOS ONE’s publication criteria and not, for example, on novelty or perceived impact.

For Lab, Study and Registered Report Protocols: These article types are not expected to include results but may include pilot data.

==============================

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We look forward to receiving your revised manuscript.

Kind regards,

Gbenga Olorunfemi, MBBS,MSC,FMCOG,FWASC

Academic Editor

PLOS ONE

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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?

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

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

Reviewer #1: Yes

Reviewer #2: 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.-->

Reviewer #1: Yes

Reviewer #2: Yes

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-->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

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-->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: 1.The introduction and methodology are apt and clearly stated the justification for the study and objectives.

2.The authors followed sound ethical practice and also declared the funding for the study.

3.The Discussion followed sound scientific principles.

However,

1. Table 1 seems o be an unnecessary inclusion having referenced it in the manuscript and is readily available for access online. If the table must be included, it should be in the methodology section since WHO MEC was used for assessment.

2. The use of Participants when data used is secondary seems odd as information/ data was extracted from records already available. This is more so having already stated the data inclusion criteria

Reviewer #2: STRENGTHS

The study's statistical analysis exhibited several strengths, including a well-aligned cross-sectional design that effectively determined the prevalence of family planning uptake, and a large sample size that ensured adequate statistical power. The use of frequency, percentages, and 95% confidence intervals provided robust prevalence estimates, underscoring the study's success in capturing immediate postpartum contraceptive uptake.

The study effectively summarized demographics using descriptive statistics. The Pregnancy Eligibility Criteria framework added a clinical dimension. The study appropriately highlighted the dominance of injectable DMPA, spacing trends, supported WHO recommendations, and contextualized the findings against regional data to underscore the high uptake rate compared to previous studies.

LIMITATIONS

The absence of multivariate models restricted exploration of independent predictors for family planning uptake and method choice. Confounding variables like socioeconomic status, maternal age, and comorbidities could have influenced outcomes. Furthermore, the reliance on discharge records without follow-up data introduced a time-dependent bias, as the study could not assess long-term adherence to contraceptive methods. Advanced techniques like survival analysis could have enriched the investigation of interpregnancy intervals.

In conclusion, the study’s findings provide valuable insights into postpartum contraceptive uptake in a high-risk population. Strengthening the analysis with multivariate modeling and advanced statistical methods would enhance the study’s rigor and applicability.

TYPOGRAPHICAL ERRORS

Pg 8: delete full stop at the end of the title

Pg 14: (Statistical Analysis) correction “confident interval” for “confidence interval”

Pg 15: (Results) correction “summarized” for “summarized” consistency in British spelling

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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: No

Reviewer #2: Yes: Ogelle, Onyecherelam Monday

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-->PONE-D-24-39098R1-->

Prevalence and sociodemographic risk and morbidities associated with contraceptive uptake among postpartum women at Tygerberg Academic Hospital, Cape Town: A cross-sectional study.

PLOS ONE

Dear Dr. Sproul,

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 Aug 20 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.

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We look forward to receiving your revised manuscript.

Kind regards,

Dubale Dulla Koboto, MSc

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

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Reviewer #1: (No Response)

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-->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: No

**********

-->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: Thank you for requesting my opinion of this manuscript.

The importance of postpartum contraception in maternal morbidity and mortality reduction is well documented. However I have the following observations:

1. Title: While I agree with Prevalence as being the main objective, `Sociodemographic risk and morbidity associated with contraception` was not studied, but rather as part of the eligibility criteria. I suggest that the title be reviewed.

2. Aim: The aim, lines 73-78 should be rephrased. Line 78 seems presumptuous and and conclusive before the study.

3. Methodology: The study cannot be cross-sectional and prospective at the same time as stated by the researchers. The data could as well have be collected retrospectively from January to July 2023. The methodology should be revised. The WHO eligibility criteria being a readily available document as referenced(Table 1) need not be included.

4. Conclusions: This need rephrasing . Lines 341-348 cannot be deduced and recommendation made as such.

5. Generally: Mixed British and American English abound in the write-up, eg Organization, recognised, individualized in lines 59, 51, 68 as examples. writer can crosscheck and provide uniformity.

Other observations are in the suggestion in the attached as annotation.

Above are my suggestions.

Thank you

Dr. Abah MG

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Reviewer #1: No

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Attachments

Attachment

Submitted filename: PONE-D-24-39098_R1.docx

-->PONE-D-24-39098R2-->-->Contraceptive Uptake in the Postpartum Period: Prevalence Among Women Attending Tygerberg Academic Hospital-->-->PLOS One

Dear Dr. Sproul,

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 03 2026 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 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,

Alejandro Torrado Pacheco, PhD

Associate Editor

PLOS One

on behalf of

Alfredo Luis Fort, M.D., M.Sc., Ph.D.

Academic Editor

PLOS One

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Additional Editor Comments:

This is the 2nd Revision for this manuscript. Although it has been importantly improved, there are several places where better descriptions would mean better understanding to readers. Also, the most important change that I consider needs to be done is not to use the word "Prevalence" since the numbers found in the study do not coincide with the definition of prevalence as representative within the larger community. I am taking the decision to accept the manuscript but right after you the authors have made the necessary small but important changes I suggest in the attached file. Thanks!

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Attachments

Attachment

Submitted filename: PONE-D-24-39098_R2-AF.pdf

Contraceptive Uptake and Characteristics in the Immediate Postpartum Period Among Women Attending Tygerberg Academic Hospital

PONE-D-24-39098R3

Dear Dr. Sproul,

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,

Alfredo Luis Fort, M.D., M.Sc., Ph.D.

Academic Editor

PLOS One

Additional Editor Comments (optional):

The authors made great efforts to improve the several inconsistencies and some writing that needed improvement. So, it is now ready for publication (minor edits may be needed but that's OK during the publication process). Well done.