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. 2021 Jun 4;16(6):e0252745. doi: 10.1371/journal.pone.0252745

Barriers and motivators of contraceptive use among young people in Sub-Saharan Africa: A systematic review of qualitative studies

Luchuo Engelbert Bain 1,2,*, Hubert Amu 3, Elvis Enowbeyang Tarkang 3
Editor: Eugene Kofuor Maafo Darteh4
PMCID: PMC8177623  PMID: 34086806

Abstract

Background

In sub-Saharan Africa, about 80% of young women either use a traditional method or do not use any form of contraception at all. The objectives of this review were to ascertain the barriers and motivators of contraceptive use among young people in Sub–Saharan Africa.

Materials and methods

We conducted electronic literature searches in PubMed, EMBASE, Ebsco/PsycINFO and Scopus. We identified a total of 4,457 publications and initially screened 2626 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A total of 13 qualitative studies were retained for the final analysis based on the Joanna Briggs criteria for assessing qualitative studies. The systematic review is registered on PROSPERO with identifier CRD42018081877.

Results

Supportive social networks, respect for privacy and confidentiality, ready availability, affordability and accessibility of contraceptives, as well as the desire to prevent unintended pregnancy and sexually transmitted infections were the motivators of contraceptive use among young people in sub-Saharan Africa. Despite these motivators, myriad of personal, societal, and health systems-based barriers including myths and misconceptions, known side effects of contraceptives, prohibitive social norms, and negative attitude of health professionals were the major barriers to contraceptive use among young people.

Conclusion

Sub-Saharan African countries with widespread barriers to contraceptive use among young people may not be able to achieve the Sustainable Development Goal 3.8 target of achieving health for all by the year 2030. Interventions intended to improve contraceptive use need to be intersectoral and multi-layered, and designed to carefully integrate the personal, cultural, organizational and political dimensions of contraception.

Introduction

Pregnancy and childbirth among young women remain major public health concerns worldwide [1]. In low- and middle-income countries (LMICs), about 16 million girls aged 15 to 19 years give birth every year, with about 2.5 million being under the age of 16 years [1]. In sub-Saharan Africa (SSA), about 13% of pregnancies end up in abortions and 97% of these are unsafe [2]. Optimal contraceptive use alone has the capacity of reducing the burden of unintended pregnancies and abortions by one third [3, 4]. High levels of contraceptive failure or discontinuation are accrued predominantly to the use of traditional methods (coitus interruptus [withdrawal method], lactational amenorrhea method, calendar/rhythm method, cervical mucus method, and abstinence), and consequently increase the overall burden of unintended pregnancies and abortions in SSA [4].

With many SSA countries still having challenges the provision of optimal access to safe abortion care, non–use or inconsistent use of contraceptives account for most of the unsafe abortions. The effects are high maternal mortality and morbidity rates, especially among young people [1]. The contraceptive challenges and their resultant morbidities and mortalities occur at the backdrop that SSA countries have signed up to meeting the Sustainable Development Goal (SDG) 3.8 target of achieving health for all by the year 2030 [5, 6]. Achieving health for all, therefore, implies that the countries have to, among other things increase the level of contraceptive use among their populace especially young people. Young people according to the World Health Organisation [7] are people 10–24 years old. Intrauterine devices and contraceptive implants, also called Long-Acting Reversible Contraceptives (LARC) are the most effective reversible contraceptive methods [8] and are highly recommended for young people [9, 10].

Despite high levels of awareness that have been reported in the literature regarding contraceptives in SSA, utilisation has been overwhelmingly sup-optimal [1116]. In SSA, however, about 80% of young people use traditional methods or do not use any form of contraception at all [8]. This review was, therefore, guided by two objectives which were to ascertain the barriers to contraceptive use and explore the motivators of contraceptive use among young people in SSA. Findings from this review could be potentially relevant in adequately planning and implementing public health interventions among this target group.

Materials and methods

A comprehensive search was performed in the bibliographic databases: PubMed, Embase.com, Ebsco/PsycINFO and Scopus in collaboration with the medical librarian of the Vrije Universiteit, Amsterdam. A review protocol was developed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-statement (www.prisma-statement.org). Databases were searched from inception up to 10th September 2019. The following terms were used (including synonyms and closely related words) as index terms or free-text words: “Africa South of the Sahara”, “sub-Saharan Africa” “Adolescent”, “Young women”, “young people” “Family Planning”, “Contraception”, (contraceptives) “Birth Control”, “young female”, “teen”, “family planning”, “barrier”, “factor”, “enablers”, “facilitators”, “predictor”, “determinant”. The search was performed without date, language or publication status restriction. Duplicate articles were excluded. The full search strategies for all databases can be found in the Supplementary Information. The systematic review is registered on PROSPERO with identifier CRD42018081877.

Only qualitative studies were retained for the final review. Our decision to include only qualitative studies was informed by the paucity of qualitative analyses especially in terms of reviews in SSA. We thus sought to bridge this gap by providing a deeper and more holistic appreciation of the barriers and motivators of young people’s contraceptive use. To ensure the trustworthiness of the themes and sub-themes generated, two independent researchers were involved in the selection of articles. The reviewers compared and decided upon the articles to be retained for final review after discussing and coming to a consensus. In addition to these, two reviewers assessed clear reporting of aims and objectives of the study, adequate description of the context in which the research was carried out, adequate description of the sample and the methods by which the sample was identified and recruited, adequate description of the methods used to collect data, and adequate description of the methods used to analyse data. A third reviewer was on standby to be involved if disagreement happens between the two reviewers. The Joanna Briggs criteria for assessing qualitative studies were used [17] with a particular focus on the critical appraisal checklist for qualitative research, to determine the eligibility of studies included in the final review. Methodological insights reported by Uman (2011) were applied in the data interpretation and discussion phases of the study [18]. We used conceptual thematic analysis to re-categorise the barriers and motivators reported by the studies into major themes, sub-themes, and their respective codes. These were then organised in the form of tables.

Results

Background of studies included in the review

Electronic search through relevant databases yielded a total of 4,457 publications. Out of this, 2,626 articles were screened based on article title and abstracts. At this stage, 2,475 were excluded due to unfit title and abstract. The remaining 151 full-text articles were further screened for eligibility and 134 were expunged. A total of 13 studies were finally retained. Fig 1 presents the PRISMA flow diagram of the literature selection. The studies spanned the period 2000 to 2018 (See Table 1). Four were conducted in Ghana and two in South Africa. Mali, Nigeria, Uganda, Kenya, Tanzania, Mozambique, and Senegal each recorded one study. While 12 of the studies generally targeted young people, one focused on young people with disabilities. Concerning methods of data collection, seven of the studies used only in-depth interviews, three studies used only focus group discussions, and one adopted IDI and FGD. Of the remaining two studies, one added responses of young people in a general discussion to FGDs while the other one added informal conversation and observation to IDI and FGD. For 12 of the studies, sample sizes used ranged from 15 to 149. Ten of the studies focused on all contraceptives while one focused on condoms. The remaining two also focused on emergency contraceptives and modern contraceptives respectively (See Table 1).

Fig 1. PRISMA flow diagram.

Fig 1

Table 1. Background of studies included in the final review.

Author(s) Year Country Contraceptives of focus Age groups Data collection methods Sample size
Patient et al. [19] 2000 South Africa Condoms 15–24 FGD 88
Otoide et al. [20] 2001 Nigeria All 15–24 FDG 149
Castle [21] 2003 Mali All 15–24 IDI 84
Flaherty et al. [22] 2005 Uganda All 14–20 FGD and general Discussions 29 in FGD and >500 in general discussions
Tabane&Peu [23] 2015 South Africa All 15–19 IDI 15
Ochako et al. [24] 2015 Kenya Modern Contraceptives 15–24 IDI 34
Hall et al. [25] 2015 Ghana All 15–24 IDI 63
Hokororo et al. [26] 2015 Tanzania All 15–20 FGD 49
Capurchande et al. [27] 2016 Mozambique All 15–24 IDI, FGD, informal conversation, and observation 42
Hall et al. [28] 2016 Ghana All 15–24 IDI 63
Burke et al. [29] 2017 Senegal All 18–24 (with disabilities) IDI and FGD 144
Hall et al. [30] 2018 Ghana All 15–24 IDI 63
Rokicki&Merten [31] 2018 Ghana Contraceptive pills 18–24 IDI 32

Motivators of contraceptive use

Eight out of the 13 studies reported on motivators of contraceptive use. Table 2 presents the motivators of contraceptive use as reported by the eight studies. Five main themes were realised from the review. These were: social support, protection of identity, ready availability, affordability and access, effectiveness in preventing unintended pregnancy and Sexually Transmitted Infections (STIs), and other motivations. The "other" theme was labelled as such because the motivations under the theme were mentioned by just one study in each case.

Table 2. Motivations for contraceptive use among young people in SSA.

Main theme Sub-theme Studies
Social support From friends and peers Tabane & Peu [23]
Burke et al. [29]
From family Hall et al. [30]
Burke et al. [29]
Others Tabane & Peu [23]
Protection of identity Anonymity (of purchase points[vending machines]) Patient & Orr [19]
Burke et al. [29]
Confidentiality (associated with patent medicine stores) Otoide et al. [20]
Burke et al. [29]
Ready availability, affordability, and access Accessibility Patient & Orr [19]
Burke et al. [29]
Availability (of condoms) Castle [21]
Affordability (low cost of condoms) Castle [21]
Effectiveness in preventing unintended pregnancy and STIs Preventing unintended pregnancy Castle [21]
Tabane & Peu [23]
Rokiciki & Merten (2018)
Preventing STIs Castle [21]
Others The need to maximise fertility in future (to gain status through child bearing) Castle [21]
Service providers being of the same sex with the young people Flaherty et al. [22]
Perceived quality of Pharmacy shops Burke et al. [29]

Concerning social support, three sub-themes were realised. These were: support from friends and peers, support from family, and support from other people who are neither friends nor family. Two studies reported on friends being major motivators of their contraceptive use [23, 29]. Burke et al. [29] and Hall et al. [30] also reported on the family being an important motivation for young people’s contraceptive use. Tabane and Peu [23] also indicated that apart from friends, there were "significant others" who motivate young people to utilise contraceptives.

Two sub-themes were realised from the theme on the protection of identity. These were anonymity and confidentiality. These two issues were made one theme because they both deal with concealing the identity of the young people regarding their utilization of contraceptives. Two studies made findings on anonymity [19, 29] where the study participants, for instance, indicated that the use of purchase points which were mainly vending machines offered acceptable levels of anonymity and thus, motivated them to purchase and use the contraceptives. Confidentiality was also associated with patent medicine stores in 2 studies [20, 29]. Lack of confidence in sellers of modern contraceptives was a major hindrance for young people’s utilization of contraceptives [20, 29].

Three studies also mentioned ready availability, affordability, and access to contraceptives as a major motivation for their utilization of contraceptives. Accessibility was for instance found by Patient and Orr [1] and Burke et al. [29] while availability and affordability were both found in Castle’s [21] study. According to the young people in these studies, condoms for instance were cheap and this made it possible to afford and use them. The condoms were also readily available at various points of sale for easy purchase whenever needed.

The effectiveness of contraceptives in preventing unintended pregnancy and STIs was also reported as a motivation for their utilisation. Castle [21], Tabane and Peu [23], and Rokicki and Merten [31] all made findings on the effectiveness of contraceptives in preventing unintended pregnancy. Castle [21] also reported that a major motivation for using condoms among young people was the fact that it made it possible for them to avoid contracting STIs. Other motivations mentioned by the studies comprised the need to maximise fertility in future (to gain status through childbearing) [21], service providers being of the same sex as the young people [22], and perceived quality of pharmacy shops [29].

Barriers to contraceptive use

Table 3 presents the barriers to contraceptive use which were reported by all the 13 studies included in our analyses. Three main themes were identified from the review. These were personal, societal, and health systems-based barriers. With personal barriers, five sub-themes were observed. They were: myths and misconceptions, lack/inadequate knowledge, negative attitude towards contraceptive use, known side effects of contraceptives, and financial challenges. Myths and misconceptions were the most reported personal barriers to contraceptive use. The sub-themes reported under myths and perceptions were lack of trust in contraceptives (especially condoms), colour and size of available condoms considered unsuitable, contraceptive use encourages promiscuity and straying (cheating), contraceptive use reduces sexual pleasure, risk of future infertility with contraceptive use, and perceived ineffectiveness of contraceptives in preventing conception. Five studies also reported the known side effects of contraceptives including weight gain, bleeding, high blood pressure, headache, and disruption of the menstrual cycle as personal barriers to contraceptive use among the young people.

Table 3. Barriers to contraceptive use among young people in SSA.

Main theme Sub-theme Codes Studies
Personal Myths and misconceptions Lack of trust in contraceptives (especially condoms) Patient & Orr [19]
Rokicki & Merten [31]
Colour and size of available condoms considered unsuitable Patient & Orr [19]
Contraceptive use encourages promiscuity and straying (cheating) Ochako et al. [24]
Burke et al. [29]
Rokicki & Merten [31]
Contraceptive use reduces sexual pleasure Ochako et al. [24]
Capurchande et al. [27]
Rokicki & Merten [31]
There is a risk of future infertility with contraceptive use Otoide et al. [20]
Castle [21]
Flaherty et al. [22]
Ochako et al. [24]
Perceived ineffectiveness of contraceptives in preventing conception Otoide et al. [20]
Hokororo et al. [26]
Capurchande et al. [27]
Rokicki & Merten [31]
Lack/Inadequate knowledge Poor knowledge on the mechanism of action of contraceptives and on how to utilise them Otoide et al. [20]
Flaherty et al. [22]
Tabane & Peu [23]
Hokororo et al. [26]
Capurchande et al. [27]
Rokicki & Merten [31]
Lack of reliable, trusted and non-judgemental sources of information on contraceptives Flaherty et al. [22]
Burke et al. [29]
Rokicki & Merten [31]
Negative attitude towards contraceptive use Lack of personal motivation and willingness to utilise contraception Tabane & Peu [23]
Contraceptive use (mainly condom) is boring, stressful, too much of a responsibility, and clinical Patient & Orr [19]
Tabane & Peu [23]
Capurchande et al. [27]
Known side effects of contraceptives Weight gain, headache, bleeding, high blood pressure, and disruption of the menstrual cycle Otoide et al. [20]
Tabane & Peu [23]
Ochako et al. [24]
Capurchande et al. [27]
Rokicki & Merten [31]
Financial challenges Unaffordability of contraceptives and contraceptive services Burke et al. [29]
Rokicki & Merten [31]
Societal based Social consequences of contraceptive use Divorce Castle [21]
Accusations of witchcraft Castle [21]
Stigma Hall et al. [25]
Hokororo et al. [26]
Capurchande et al. [27]
Hall et al. [28]
The tag of being promiscuous Hall et al. [30]
Social norms Disproval of contraceptive use by friends and colleagues Tabane & Peu [23]
Disproval of contraceptive use by family and the larger society Tabane & Peu [23]
Burke et al. [29]
Hall et al. [30]
Societal prohibition of discussions on issues concerning contraception Capurchande et al. [27]
Burke et al. [29]
Rokicki & Merten [31]
Contraception being considered an issue only for females Capurchande et al. [27]
Religious prohibitions Burke et al. [29]
Health systems-based Lack of privacy and confidentiality at health facilities Flaherty et al. [22]
Hokororo et al. [26]
Burke et al. [29]
Negative attitude of health professionals Being treated disrespectfully Flaherty et al. [22]
Being entirely refused contraceptive services Flaherty et al. [22]
Hokororo et al. [26]
Being denied teaching about contraceptives Tabane & Peu [23]
Discrimination Burke et al. [29]
Hall et al. [30]
Long waiting time Hokororo et al. [26]
Poor communication between health professionals and young people Overly technical language used at health facilities Capurchande et al. [27]
Burke et al. [29]
Power asymmetry in communication between health professionals and young people Capurchande et al. [27]
Physical inaccessibility of health facilities Staircases are unfriendly having to be accompanied by someone to facilitate access Burke et al. [29]

Societal-based barriers were reported by nine studies, comprising two sub-themes which were social consequences of contraceptive use and social norms. The specific societal based barriers to contraceptive use were: divorce, accusations of witchcraft, stigma, the tag of being promiscuous, disproval of contraceptive use by friends and colleagues as well as family and the larger society, societal prohibition of discussions on issues concerning contraception, contraception being considered an issue only for females, and religious prohibitions.

Health systems-based barriers which were reported by 7 of the studies comprised five sub-themes; lack of privacy and confidentiality at health facilities, negative attitude of health professionals, long waiting time, poor communication between health professionals and young people, and physical inaccessibility of buildings by the persons with disability as the sub-themes. The most-reported sub-theme was the negative attitude of health professionals which comprised being treated disrespectfully, being entirely refused contraceptive services, being denied teaching about contraceptives, and discrimination.

Discussion

In this review, we explored the barriers and motivators of contraceptive use among younger people in SSA using 13 qualitative publications. The motivators were re-categorised into social support, protection of identity, ready availability, affordability and access, effectiveness in preventing unintended pregnancy and STIs, and other motivators. The barriers were also re-categorised into personal, societal, and health systems-based barriers.

Social support was realised in our review as an important motivator of contraceptive use. Tabane and Peu [23] for instance posited that approval from friends and positive peer influence from peers greatly encourage young people to utilise contraceptives. Burke et al. [29] and Hall et al. [30] also noted that family support is an instrumental protective factor for young people’s utilisation of contraceptives. We also realised from our review that when anonymity and confidentially are assured and there is ready availability, affordability, and access, young people are highly motivated to patronise contraceptives and contraceptive services. This is an issue of importance because, young people in SSA have been known to have grave unmet needs for contraceptive use which stems from their inability to access, afford, and/or be guaranteed confidentiality when they make efforts to utilise contraceptives [32, 33].

Despite the motivators realised in our review, we observed that myriad of barriers also inhibit young people from utilising contraceptives and this has negative implications for SSA countries towards the attainment of health for all by the year 2030. Key among these challenges are myths and misconceptions. Young people according to Otoide et al. [20], Hokororo et al. [26], Capurchande et al. [27], and Rokicki and Merten [31] for instance, erroneously perceived that contraceptives were ineffective in preventing conception. They also believed that contraceptive use posed risks of future infertility [2022, 24]. The myth and misconceptions realised in our review could have been due to lack of knowledge which Otoide et al. [20], Flaherty et al. [22], Tabane and Peu [23], Hokororo et al. [26], Capurchande et al. [27], Burke et al. [29] and Rokicki and Merten [31] found as comprising poor knowledge on the mechanism of action of contraceptives and on how to utilise them and lack of reliable, trusted and non-judgmental sources of information on contraceptives was also reported by seven of the studies. The findings of our review regarding knowledge point to its essential role in the reproductive health decision making of young people including contraception [3437].

Our review showed that the known side effects of contraception such as weight gain, bleeding, headaches, high blood pressure, and disruption of the menstrual cycle were personal barriers to contraceptive use among the young people. If such fears are not effectively managed through innovative approaches which reassure them of the important reasons for utilisation, such young people would continue to shy away from contraceptive use and this would not auger well for the achievement of universal health coverage by countries in SSA. Besides, financial challenges which were mainly about the unaffordability of contraceptives and contraceptive services remained major barriers to the young people in their quest to utilise the contraceptives according to Burke et al. [29] and Rokicki and Merten [31]. This finding, however, contradicts arguments by Castle [21] that young people in her study felt contraceptives were affordable and this served as a motivation for them in utilizing such contraceptives.

Attitude of health professionals towards clients is an important determinant of health care utilisation [3840]. The negative attitude of health professionals towards young people was reported by Flaherty et al. [22], Tabane and Peu [23], Hokororo et al. [26], Burke et al. [29], and Hall et al. [30] as a health systems-based barrier to contraceptive use among young people and this manifested in being treated disrespectfully, being entirely refused contraceptive services, being denied teaching about contraceptives, and discrimination. Our finding of physical inaccessibility of buildings as reported by Burke et al. [29] where staircases were unfriendly and the physically challenged young people needing to be accompanied by someone, points to the general neglect of the rights of persons with physical disabilities to these buildings [41]. Our finding thus justifies calls for the physical environment to be designed and equipped to meet the needs of persons with disabilities (PWDs) and prioritization of their needs through national planning, budgeting and other national programmes.

Social norms are powerful societal factors which predict the health-seeking behaviour of people. In our review, we realised that these norms militated against the utilisation of contraceptives among young people in the form of disproval of contraceptive use by friends and colleagues, disproval of contraceptive use by family and the larger society, societal prohibition of discussions on issues concerning contraception, and contraception being considered an issue only for females. The continuous prevalence of such inhibitive social norms in SSA would only continue to preclude young people in these countries from utilizing contraceptives and thus making it impossible for the countries to achieve universal levels of contraceptive use.

In most SSA countries, major contraceptive interventions have included the promotion and delivery of contraceptives during the postpartum period, expansion of long-acting contraceptive options, and community-based contraceptive outreach and service delivery [42, 43]. The effectiveness of these interventions has, however, been a major challenge as they mainly do not yield the expected results for which they are implemented which warrant the adoption of alternative interventions proven to be effective [43, 44].

Conclusions

Our review revealed social support, protection of identity, ready availability, affordability and access, effectiveness in preventing unintended pregnancy and STIs as motivators of young people’s utilization of contraceptives in SSA. Despite the availability of these motivators, myriad of personal, societal, and health systems-based barriers prevail and prevent the young people from utilizing the contraceptives. These barriers include myths and misconceptions, lack/inadequate knowledge on contraceptives, known side effects of contraceptives, financial challenges, prohibitive social norms, negative attitude of health professionals, physical inaccessibility of buildings, and poor communication between health professionals and young people. The perpetuation of these barriers implies that many SSA countries, especially those from which the barriers where identified may not be able to achieve the SDG target of health for all by the year 2030.

Recommendations

To ameliorate the barriers to contraceptive use and accelerate the progress of SSA countries towards the achievement of health for all by the year 2030, we proffer these policy recommendations:

  1. There is a need for community engagements to improve prohibitive social norms to make them more receptive towards contraceptive use and discussions regarding contraception.

  2. Contraceptive service provision should be made friendly in countries which are not already implementing such young people-friendly contraceptive services. In such countries, there should, for instance, be a re-conscientization of health professionals to improve their attitudes towards young people in the provision of contraceptive services to them. Privacy and confidentiality should be afforded the young people in their utilisation of services.

  3. Efforts should be made by respective SSA countries to make public health facilities accessible for persons living with disabilities.

  4. To reduce financial barriers, voucher schemes which have been implemented in some countries, could be adopted by other countries for young people to access subsidised or free contraceptive services.

Strengths and limitations

Our study is the first effort at exploring the barriers and motivations for contraception among young people using purely qualitative studies. The fact that we reviewed only qualitative studies, however, meant that other relevant papers reporting barriers and motivations for contraceptive use among young people were expunged. It is, however, noteworthy that such studies could have contributed to a better understanding of the totality of the barriers and motivators for young people’s contraceptive use.

Supporting information

S1 File. PRISMA checklist.

(DOC)

S2 File. List of articles included in the review.

(DOCX)

Abbreviations

FGD

Focus Group Discussion

LARC

Long-Acting Reversible Contraceptives

PRISMA

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

STI

Sexually Transmitted Infection

SDG

Sustainable Development Goal

SSA

Sub-Saharan Africa

WHO

World Health Organisation

Data Availability

All relevant data are in the paper and its Supporting Information files.

Funding Statement

The authors received no specific funding for this work.

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Decision Letter 0

Eugene Kofuor Maafo Darteh

20 Oct 2020

PONE-D-20-10773

Barriers to and motivations for contraceptive use among adolescents and young women in Sub-Saharan Africa: A systematic review of qualitative studies

PLOS ONE

Dear Dr. Luchuo Engelbert Bain,

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.

Kindly revise your manuscript taking into cognisance the comments of the reviewers.

Please submit your revised manuscript by 15th December, 2020. 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'.

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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,

Eugene Kofuor Maafo Darteh, Ph.D.

Academic Editor

PLOS ONE

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 [NO : The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript].

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Please include your amended statements within your cover letter; we will change the online submission form on your behalf.

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In your revised cover letter, please address the following prompts:

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[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: N/A

Reviewer #2: N/A

**********

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: No

**********

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: Authors need to go through the PDF document of the manuscript where reviewer comments are included.

The objective/question of the review was on three areas but only two of the questions were answered with the review. One question remains to be answered.

Reviewer #2: This is a systematic review on Barriers to and motivations for contraceptive use among adolescents and young women in Sub-Saharan Africa. Since low contraceptive usage is a challenge African countries are grabbling with, synthesising knowledge to identify gaps is important for public health.

Introduction: Pg3 The age range for young people includes adolescents. So why separate adolescents and young people in your population of interest?

Methods: Pg 4 "the reviewers met" does not connote an objective process. Why was it not done independently and if necessary a third person adjudicates in the event of indecision?

Policy recommendations: There is no indication from your write up on what policies countries have in place with regards to contraceptive usage for readers to appreciate if your policy recommendations are necessary. As it is no one knows what the countries within the review are doing.

General comments:

1. There are so many recommendations authors could give. For instance taking a look at Table 1, the age groups of included studies indicate a gap. As indicated in the introduction the age group is 10-24 years but the selected studies lack on age group 10-13 who are also sexually active.

2. One would have expected that as what is known is being synthesised authors will identify gaps that need closing with research to win the low contraceptive battle. Because, bringing together what is available in the articles is not enough. This is concluded like a research based on a primary data. Gaps must be identified. Therefore as it is, a major revision is needed.

3. There's the need for editing to correct typographical errors

4. Authors failed to indicate why the focus is on qualitative studies

**********

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: Hailemariam Segni A. (MD, MPH, Gyn/Obs)

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.

Attachment

Submitted filename: PONE-D-20-10773_reviewer.pdf

PLoS One. 2021 Jun 4;16(6):e0252745. doi: 10.1371/journal.pone.0252745.r002

Author response to Decision Letter 0


2 Dec 2020

Response to Reviewers

At this time, please address the following queries:

a. Please clarify the sources of funding (financial or material support) for your study. List the grants or organizations that supported your study, including funding received from your institution.

Response: This study did not receive any funding.

b. State what role the funders took in the study. If the funders had no role in your study, please state: “The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.”

Response: No funding was received for this study

c. If any authors received a salary from any of your funders, please state which authors and which funders.

Response: No salaries were received from funders.

d. If you did not receive any funding for this study, please state: “The authors received no specific funding for this work.”

Response: “The authors received no specific funding for this work.”

Please include your amended statements within your cover letter; we will change the online submission form on your behalf.

Response:

4.We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions.

Response:

In your revised cover letter, please address the following prompts:

a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent.

Response:

5. Review Comments to the Author

Reviewer #1:

Authors need to go through the PDF document of the manuscript where reviewer comments are included.

Response: this has been done and all issues raised by the reviewer have been pasted in the “response to reviewers” document and duly addressed

The objective/question of the review was on three areas but only two of the questions were answered with the review. One question remains to be answered.

1. Search was conducted from a small number of data bases were searched.

Response: Thank you for this comment. Based on previous studies including those published in Plos One, we believe that the number of databases searched were exhaustive enough to ensure we retrieve all relevant publications. We actually searched PubMed, EMBASE, Ebsco/PsycINFO and Scopus. Searching other sources may only create further duplication of papers as these are the most popular databases available.

2. Too many papers (4457) were retrieved from which only 13 were eligible. Maybe the search terms used were not refined enough?

Response: Our study focused only on qualitative studies which was the reason for the rather small number of papers included in the final review. We have also detailed the search tersm in the methods section and believe that the terms used were exhaustive enough to produce the expected results.

3. The review has not answered one of the questions, Prevalence and usage.

Response: The focus of this systematic review was only on the barriers and motivations for contraceptive uptake among young people.

4. The protocol mentioned Prevalence and usage as one of the questions to be answered.

Response: The main review has focused only on the barriers and motivations

5. Enough number of data bases were not searched from.

Response: Thank you for this comment. Based on previous studies including those published in Plos One, we believe that the number of databases searched were exhaustive enough to ensure we retrieve all relevant publications. We actually searched PubMed, EMBASE, Ebsco/PsycINFO and Scopus. Searching other sources may only create further duplication of papers as these are the most popular databases available.

6. This maybe one of the reasons why you had too many non-eligible studies during the search. Restriction of time of study and/or publication is one thing to seriously consider.

Response: We agree with the reviewer that this is a plausible explanation of the high number of non – eligible studies we had. However, empirical qualitative research on the subject was not very rampant, and we wanted to be an inclusive as possible.

7. What about during a situation of failure to reach at consensus between the two reviewers? You need to have a third tie breaker reviewer in the team.

Response: Even though a third reviewer was on standby, no such disagreements emerged between the two reviewers which required his inputs. That is why it has not been mentioned in the manuscript.

8. Prevalence and usage?

Response: This has not been explored in our current review even though contained in the registered protocol.

9. Physical inaccessibility of buildings by the persons with disability" should be discussed here as one of the major barriers.

Response: This has been done. See page 11.

10. "Physical inaccessibility of buildings by the persons with disability" should be part of the conclusion section as a major barrier.

Response: This has been done. See page 12.

11. It is very difficult to reach at this type of conclusion based on this systematic review.

Response: We have refined the statement to indicate that some countries, especially the ones from which the studies were reviewed, may not be able to achieve the SDG target with the persistence of the barriers identified. See page 12.

Reviewer #2:

This is a systematic review on Barriers to and motivations for contraceptive use among adolescents and young women in Sub-Saharan Africa. Since low contraceptive usage is a challenge African countries are grabbling with, synthesising knowledge to identify gaps is important for public health.

Introduction: Pg3 The age range for young people includes adolescents. So why separate adolescents and young people in your population of interest?

Response: We have revised the manuscript to focus only on young people.

Methods: Pg 4 "the reviewers met" does not connote an objective process. Why was it not done independently and if necessary a third person adjudicates in the event of indecision?

Response: the phrased has been revised accordingly (See page 5). Also, while a third reviewer was actually on standby, no serious disagreements in terms of what to include in the final review emerged and so that reviewer did not intervene.

Policy recommendations: There is no indication from your write up on what policies countries have in place with regards to contraceptive usage for readers to appreciate if your policy recommendations are necessary. As it is no one knows what the countries within the review are doing.

Response: A writ-up has now been included in the discussion in this regard. See page 12.

General comments:

1. There are so many recommendations authors could give. For instance taking a look at Table 1, the age groups of included studies indicate a gap. As indicated in the introduction the age group is 10-24 years but the selected studies lack on age group 10-13 who are also sexually active.

Response: A recommendation has been provided in this regard. See page 14.

2. One would have expected that as what is known is being synthesised authors will identify gaps that need closing with research to win the low contraceptive battle. Because, bringing together what is available in the articles is not enough. This is concluded like a research based on a primary data. Gaps must be identified. Therefore as it is, a major revision is needed.

3. There's the need for editing to correct typographical errors

Response: This has been done. An English language expert has proof-read the manuscript.

4. Authors failed to indicate why the focus is on qualitative studies.

Response: This has been done. See page 5.

Attachment

Submitted filename: Response to Reviwers CommentsA-Reviewplosone.doc

Decision Letter 1

Eugene Kofuor Maafo Darteh

12 Jan 2021

PONE-D-20-10773R1

Barriers to and motivations for contraceptive use among young people in Sub-Saharan Africa: A systematic review of qualitative studies

PLOS ONE

Dear Dr. Luchuo Engelbert Bain,

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.

Kindly address the minor comments of the reviewers.

Please submit your revised manuscript by 11th March 2021 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: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Eugene Kofuor Maafo Darteh, Ph.D.

Academic Editor

PLOS ONE

[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: All comments have been addressed

Reviewer #2: (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

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: N/A

**********

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

Reviewer #2: 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

Reviewer #2: (No Response)

**********

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: Reviewer’s comments 2

• Title: it is better if written as “Barriers and motivators of contraceptive use among young people in Sub Saharan Africa: a systematic review of qualitative studies”.

• Key words: replace “Motivation” with “Motivators”.

• Methods: you need to include in methods section that a third reviewer was standby to be involved if disagreement happens between the two reviewers but there was need for it.

• Some editorial work is still needed.

Reviewer #2: Please I do not see the response authors indicated to be on page 12 of the manuscript to be a response to the request to provide existing policies on the various countries from where studies have been included. This is to contextualise and make relevant the policy recommendations.

**********

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: Hailemariam Segni Abawollo, MD/OB-GYN, MPH

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.

Attachment

Submitted filename: Reviewers second round comments.docx

PLoS One. 2021 Jun 4;16(6):e0252745. doi: 10.1371/journal.pone.0252745.r004

Author response to Decision Letter 1


17 Jan 2021

RESPONSE TO REVIEWERS

Reviewer #1: Reviewer’s comments 2

• Title: it is better if written as “Barriers and motivators of contraceptive use among young people in Sub Saharan Africa: a systematic review of qualitative studies”.

Response: The title has been revised as recommended by the reviewer. See page 1

• Key words: replace “Motivation” with “Motivators”.

Response: The change has been made as the reviewer recommended. See page 3

• Methods: you need to include in methods section that a third reviewer was standby to be involved if disagreement happens between the two reviewers but there was need for it.

Response: The addition has been made. See page 6

• Some editorial work is still needed.

Response: Some more editing has been done on the manuscript

Reviewer #2: Please I do not see the response authors indicated to be on page 12 of the manuscript to be a response to the request to provide existing policies on the various countries from where studies have been included. This is to contextualise and make relevant the policy recommendations.

Response: Please see page 13, lines 271-276

Decision Letter 2

Eugene Kofuor Maafo Darteh

11 Apr 2021

PONE-D-20-10773R2

Barriers and motivators of contraceptive use among young people in Sub Saharan Africa: a systematic review of qualitative studies

PLOS ONE

Dear Dr. Luchuo Engelbert Bain,

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.

You are requested to revise the manuscript focusing on the recommendations. Ensure that the recommendations are reason and doable.  

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We look forward to receiving your revised manuscript.

Kind regards,

Eugene Kofuor Maafo Darteh, Ph.D.

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 #2: (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 #2: (No Response)

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

Reviewer #2: N/A

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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 #2: Yes

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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 #2: No

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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 #2: Materials and methods

1. Please correct the sentence in line #101-103

Recommendations

1. Line #275: There is an omission in the sentence

2. Recommendation 1(line #273-276): but literature showed knowledge does not always translate to action, so authors should be recommending something other than increasing knowledge

3. Recommendation 3 (line #279-282): I know a country included in the review that is already practicing this, so you can’t box them together to still do this. Unless the country is facing implementation challenges. Then you suggest a separate recommendation to that effect.

4. Recommendation 5 (line#285-286): a country in your review has begun implementing free FP in pockets of places and not scaled up nationwide though. But your suggestion implies all countries should implement without considering what others are doing.

5. It is for these reasons I suggested you provide a context on the countries (i.e. policy) from which studies are included for your audience to appreciate things better.

**********

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 #2: No

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PLoS One. 2021 Jun 4;16(6):e0252745. doi: 10.1371/journal.pone.0252745.r006

Author response to Decision Letter 2


19 Apr 2021

6. Review Comments to the Author

Reviewer #2: Materials and methods

1. Please correct the sentence in line #101-103

Response: The correction has been made as the reviewer suggested (See page 6)

Recommendations

1. Line #275: There is an omission in the sentence

Response: The entire sentence has been deleted in response to a subsequent comment made by the reviewer. See page 14.

2. Recommendation 1(line #273-276): but literature showed knowledge does not always translate to action, so authors should be recommending something other than increasing knowledge

Response: The recommendation has been deleted based on the reviewer’s comments.

3. Recommendation 3 (line #279-282): I know a country included in the review that is already practicing this, so you can’t box them together to still do this. Unless the country is facing implementation challenges. Then you suggest a separate recommendation to that effect.

Response: We have reviewed the suggestion to focus on countries which are not already implementing friendly contraceptive services for young people. See page 15.

4. Recommendation 5 (line#285-286): a country in your review has begun implementing free FP in pockets of places and not scaled up nationwide though. But your suggestion implies all countries should implement without considering what others are doing.

Response: We have revised the recommendation to focus on countries which are not already implementing the voucher schemes.

5. It is for these reasons I suggested you provide a context on the countries (i.e. policy) from which studies are included for your audience to appreciate things better

Response: We have deleted the recommendation. See page 15.

Decision Letter 3

Eugene Kofuor Maafo Darteh

24 May 2021

Barriers and motivators of contraceptive use among young people in Sub Saharan Africa: a systematic review of qualitative studies

PONE-D-20-10773R3

Dear Dr. Luchuo Engelbert Bain,

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.

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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,

Eugene Kofuor Maafo Darteh, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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 #2: All comments have been addressed

**********

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 #2: Yes

**********

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

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.

Reviewer #2: 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 #2: 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 #2: (No Response)

**********

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 #2: No

Acceptance letter

Eugene Kofuor Maafo Darteh

27 May 2021

PONE-D-20-10773R3

Barriers and motivators of contraceptive use among young people in Sub-Saharan Africa: A systematic review of qualitative studies

Dear Dr. Engelbert Bain:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

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 plosone@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. Eugene Kofuor Maafo Darteh

Academic Editor

PLOS ONE

Associated Data

    This section collects any data citations, data availability statements, or supplementary materials included in this article.

    Supplementary Materials

    S1 File. PRISMA checklist.

    (DOC)

    S2 File. List of articles included in the review.

    (DOCX)

    Attachment

    Submitted filename: PONE-D-20-10773_reviewer.pdf

    Attachment

    Submitted filename: Response to Reviwers CommentsA-Reviewplosone.doc

    Attachment

    Submitted filename: Reviewers second round comments.docx

    Data Availability Statement

    All relevant data are in the paper and its Supporting Information files.


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