Author’s response to reviews Title: The long-term effects of adolescent pregnancies in a community in Northern Ghana on subsequent pregnancies and births of the young mothers Authors:

1. The paper states (p.6), "women ... who could not afford to visit a hospital ... were offered a free consultation..." and "thus, only women with actual health complaints were considered in the study." How do the authors address concerns that women who have poorer health than the general population make up the sample and thus may bias the outcomes? For example, one study found that women who had recurrent stillbirth had a two-fold incidence of diabetes and hypertensive disorder compared to those who experienced their first stillbirth (Samueloff et al 1993 http://europepmc.org/abstract/med/8277486 ) How do the authors account for concerns about the possible poor health of sample subjects, and its influence on pregnancy outcomes?