Title:prevalence and Determinants of Unintended Childbirth in Ethiopia Authors' Response to Reviews Title: Prevalence and Determinants of Unintended Childbirth in Ethiopia

Conclusions sections should be more focused indicating a few of the recommended strategies in the article which should be implemented to improve family planning in Ethiopia. As it is now, it is highly general. Conclusion part refined and made more focussed as per the specific findings. It reads now as “The study found a relatively high prevalence of unintended childbirth in Ethiopia and this implies high levels of unmet need for child spacing and limiting. There is much need for better targeted family planning programs and strategies to strengthen and improve access to contraceptive services, to raise educational levels, and related information and communication particularly for those affected groups including young, unmarried, multipara, and those with less than secondary level of education. Further quantitative and qualitative research on the consequences of unintended pregnancy and childbirth related to prenatal and perinatal outcomes are vital to document process of change in the problem overtime.” Introduction Paragraph 1: Africa 5.2 million; Sub-Saharan Africa 5.5 million – please check again. Africa 5.2 million corrected as 6.2 million. Paragraph 4: 2015 (Ethiopia 2007/2008) and not Ethiopia 1993 – Please correct 2015 in this context refers to the last year of the MDG period (1990-2015) which is in G.C. but not in Ethiopian calendar. Hence we maintained it as it is. Last paragraph: DHS 2011 should be changed to EDHS 2011 Done. Last paragraph: Corrected accordingly as per the suggestions: “In Ethiopia, the percentage of births that were unwanted or unplanned at the time of conception was 37%, 35% and 28% in the 2000, 2005, and 2011 respectively [12]. A cross-sectional study from Eastern Ethiopia shows that 33.3% of sexually active women had their most recent pregnancies classified unintended and the prevalence of unintended childbirth was 14.4% [19]. Another study from the same region shows a 27.9% unintended pregnancy level (13). A nationwide facility based study shows 42% unintended pregnancies [14]. The studies indicate that younger, unmarried, and multipara women and those among the poor wealth quintiles have higher experience of unintended pregnancies [13, 15].” Methodology The use of “intended” in this study in place of “wanted” in the EDHS and the same for “unintended” is not acceptable and does not signify the same meaning. Suggest keeping “wanted” and “unwanted” as it is used in the EDHS. The operational definitions of intended and unintended used in the paper are not acceptable unless they have been specifically used in the EDHS methodology. A study that is doing a secondary analysis on a previous database cannot in my view go into the process of providing operational definition of study subjects other than the one already used in the parent study. This creates too much of a bias. Regarding the terms used to define the outcome variable, the authors preferred the use of “intended=0 vs unintended=1” instead of “wanted or unwanted” for the following reasons: • Though the term “intended” has an equivalent meaning to “wanted” in this context, “unintended” and “unwanted” do not carry the same meaning. According to EDHS, “if the birth or pregnancy was wanted then, it is considered to be planned. It is considered to be mistimed if it was wanted but at a later time, and considered to be unwanted if it was not wanted at the time of conception”. When we considered a dichotomous variable, using the term “unwanted” instead of both mistimed and unwanted births would be confusing which would bring different understanding from that of the EDHS report. Hence, to harmonize this, we preferred to use the terms “intended vs unintended”. We didn’t intend to give an operational definition which would bring a different meaning to that of the EDHS report. Unintended childbirth in this case refers to the last birth that was not wanted or that was mistimed at the time of conception or it refers to the proportion of births resulting from unintended pregnancies. • Many previous studies used the terms “intended vs unintended” and yet respondents were asked same kind of series of questions used in the DHS. • We believe using the terms “wanted or unwanted” as a whole would seem judgmental on the approach of the analysis. However, we would appreciate for any further advice on this regard so that we can harmonize the different views to make the article more informative. Results: Most of the result section in the initial paragraphs describes the frequency of the findings in percentages without indicating the significance level of the findings either in p values, unadjusted and adjusted odd’s ratios. Better to include those from the initial results section and summarize the results section. The remainder of the results section is well organized. The results section is summarized again and the unadjusted (chi-square) significance levels are included in the revised version. Details are reduced as the findings are available in the tables and figures.