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Factors Affecting Selected Contraseptive Method in PKBRS RSUP Dr. Mohammad Hoesin Palembang 2017 Muthiah Azzahrah Arisa Putri Arisa Putri1, Mgs. M. Irsan Saleh2, Veny Larasati3 1.

Program Studi Pendidikan Dokter, Fakultas Kedokteran, Universitas Sriwijaya, 2. Bagian Biomedik, Fakultas Kedokteran, Universitas Sriwijaya 3. Bagian Biomedik, Fakultas Kedokteran, Universitas Sriwijaya Jl. Dr. Mohd. Ali, Kompleks RSMH, KM. 3,5, Palembang, 30126, Indonesia Telp/Fax: +62711316671/+62711373438 Email: [email protected]

Abstrak Program KB dicanangkan pemerintah untuk menekan laju pertumbuhan penduduk. Pusat Data dan Informasi Kementerian Kesehatan Republik Indonesia (2017), mencatat pada tahun 2016 peserta KB baru sebanyak 6.663.156 dan KB aktif sebanyak 36.306.662 peserta, meliputi peserta kondom 3,23%, peserta pil 22,81%, peserta suntik 47,96%, peserta IUD 10,61%, peserta MOW 3,54%, dan peserta MOP 0,64%. Tujuan dari penelitian ini adalah untuk mengetahui faktor-faktor yang mempengaruhi pemilihan Contraceptive methods di PKBRS Rumah Sakit Dr. Mohammad Hoesin Palembang. Penelitian ini merupakan penelitian destkriptif analitik dengan desain cross sectional terhadap data rekam medik peserta KB di di PKBRS Rumah Sakit Dr. Mohammad Hoesin Palembang dari bulan September sampai November 2018. Pengambilan sampel secara total sampling dengan mencatat karakteristik peserta KB yaitu umur, riwayat paritas, tingkat pendidikan dan pekerjaan. Data dianalisis secara bivariat dengan uji Chi square dan untuk mengetahui besar pengaruh digunakan uji regresi logistik. Pada 476 sampel peserta KB, pemilihan Contraceptive methods dengan IUD sebanyak 75.0% dan non-IUD sebanyak 25.0%. Hasil uji bivariat menunjukan ada hubungan bermakna umur dan pemilihan Contraceptive methods (p=0,000) dan pada hubungan riwayat paritas dan pemilihan Contraceptive methods (p=0,014). Pada hubungan tingkat pendidikan dan pekerjaan terhadap pemilihan Contraceptive methods nilai p=0,253;p=0,874. Hasil analisis multivariat variabel independen menunjukkan bahwa usia yang adalah faktor paling berpengaruh dalam pemilihan IUD dengan nilai p=0,002. Pada peserta KB di PKBRS Rumah Sakit Dr. Mohammad Hoesin Palembang Januari-Desember 2018, faktor umur dan riwayat paritas mempunyai hubungan dengan pemilihan Contraceptive methods; dan faktor yang paling berperan ialah faktor usia. Kata Kunci : Faktor-faktor, Pemilihan Contraceptive, Contraceptive.

Abstract Family planning program launched by Indonesian government to press the population growth. Pusat Data dan Informasi Kementerian Kesehatan Republik Indonesia (2017) noted on 2016 there is 6.663.156 new family planning participants and 36.306.662 family planning active participant. covering 3.23% participants condoms, 22,81% pills participants, 47,96 % syringe participants, 10.61% IUD participants, 3,54% MOW participants , and 0,64% MOP participants. The purpose of this study is to find factors affecting selected contraceptive methods in PKBRS RSUP Dr. Mohammad Hoesin Palembang This Research using descriptive analitic with cross sectional design. Sampling done with total sampling towards KB participants in PKBRS RSUP Dr. Mohammad Hoesin Palembang and record mother’s age, parity, education, and employment status. Statistic test using Chi square test and logistic regression test. The result test obtained there is a relationship between the mother’s age (p=0,000) and parity (p=0,014) and selected contraceptive method. For education, and employment status showed result p=0,253;p=0,874. From multivariat analysis, mothers age take the biggest role in choosing contraception method (p=0,002). Among KB participants in PKBRS RSUP Dr. Mohammad Hoesin Palembang January-December 2017, mothers’s age and parity has relationship with selected contraceptive method; and the most affecting factor is mother’s age. Keywords: Factors, Selected Contraception Method.

1. Introduction Indonesia is ranked fourth in world’s largest population, placed after China, India, and America. With sum of indonesian population in 2016 is about 258,705,000 with population growth rate 1,49% every year. Indonesian population predicted will be as big as 273,3 million in 20251. Indonesian goverment already strive to supress population growth by launcing a program called Family Planning (KB) which began to be impemented since 1970.Family planning is an effort that done by a husband or wife or someone who has certain goal such as avoiding and delaying pregnancy, and stopping the pregnancy in order to reach the number of children that they desired in a family2. Family planning program has the main objective written in 2015-2019’s Rencana Pembangunan Jangka Menengah Nasional (RPJMN). The Targets include a reduction in maternal mortality rate to 309 deaths per 100,000 births, average population growth rate reduced to around 1.19% per year, decrease in total birth rates or total fertility rate (TFR) to around 2.3 per woman, unmet need or fertile age couples who do not want to have more children and want to arrange the next birth but do not use contraceptives methods are reduced to 9,9%, number of teenage birth rate to 35, use of all contraceptive methods is 66%, and the proportion of the long-term and permanent method as a proportion of modern contraceptive methods users is 23.5%3. Pusat Data dan Informasi Kementerian Kesehatan Republik Indonesia (2017) noted on 2016 there is 6.663.156 new family planning participants and 36.306.662 family planning active participant. covering 3.23% participants condoms, 22,81% pills participants, 47,96 % syringe participants, 10.61% IUD participants, 3,54% MOW participants, and 0,64% MOP participants4. Many factors that influence the choice of contraceptive method itself. There are three factors in considerating choosen contraceptives methods, named predisposing factors, enabling factors, and reinforcing factors. Predisposing factors are factors that came from itselfs including age, education, employment status, religion, number of late children, number of children living, and knowledge about contraception. These factors are also supported by the physical environment such as availability of family planning services. For the reinforcing factor in the choice of contraception method itself is manifested in the attitudes and behavior of family planning officers who are models for the

community5. From another prespective, the consideration in choosing contraception is influenced by the age of the mother, the history of parity, the agreement of the spouse, the smallest age of the child, cost, culture and level of education6. Research in Kenya showed that there was a significant relationship between the use of contraception one-year after childbirth with a parity history, education, age, and employment status7. Another research also shows that basic education, mothers’s age, total income, employment status, knowledge about contraception, cost perception, insecurity, shame, lack of information, and quality of family planning services influence a person's decision to choose the methods of contraceptive8. In addition, another research results showed that mother’s age, education, knowledge, service, partner agreement, and culture had a relationship with the selection of contraception method in active family planning acceptors9. Data of the factors that affecting the selection of contraceptive methods in the PKBRS RSUP Dr. Mohammad Hoesin Palembang is currently unknown. Therefore, researchers are interested in examining the factors that affecting the selected contraceptive methods in the PKBRS RSUP Dr. Mohammad Hoesin Palembang from January to December 2017.

2. Metodhs The type of research used was observational analytic with cross sectional design. Data is collected from secondary data collection from medical records at PKBRS RSUP Dr. Mohammad Hoesin Palembang. Sampling is done in total sampling. The sample used in this study is all medical record data of family planning participants in PKBRS RSUP Dr. Mohammad Hoesin Palembang in 2017 who fulfilled the inclusion criteria. Inclusion criteria are medical record data for family planning participants who have data of the variables that will be studied in the future and medical record data for family planning participants who live in Palembang. Meanwhile, the exclusion criteria of this study is medical records of family planning participants who have a history of gynecological diseases. The collected data is then examined by checking and validation, coding, recapitulation, and tabulation. After that, statistical analysis is carried out using IBM SPSS Statistics. The presentation of data from the research will be presented in the form of distribution tables and narratives.

3. Results Family Planning Participants From 476 family planning participants in PKBRS RSUP Dr. Mohammad Hoesin Palembang Period JanuaryDecember 2017 the proportion of contraceptive method selection with IUD as much as 75.0% and non-IUD as much as 25.0%. Tabel 1. Proportion of the choosen Contraceptive methods (n=476) Methods Total (person) Percentage IUD 357 75,0 Non-IUD

119

25,0

Total

476

100,0

Age Most of the research samples included in the 20-35 years old catogory with 70.2% or as many as 334 people. While the study sample aged over 35 years amounted to 113 people or by 23.7%, and samples aged <20 are 29 people or 6.1%. Tabel 2. Distribution of Samples based on Age (n=476) Age Total (person) Percentage >35 113 23,7 20-35 334 70,2 <20 29 6,1 Total 476 100,0

Parity History From 476 study samples, 340 had a history of parity >2 or had given birth twice or more (71.4%), while 136 others had a history of parity <2 (35.6%), Tabel 3. Distribution of Samples based on Parity History (n=476) Parity History >2 <2 Total

Total (person) 340

Percentage 71,4

136 476

28,6 100,0

Education 220 people or 46.2% of the research’s sample had low education, 197 subjects had secondary education (41.4%), and 59 others had higher education (12.4%) Tabel 4. Distribution of Samples based on Education (n=476) Education

Total (person)

Percentage

High

59

12,4

Mid

197

41,4

Low

220

46,2

Total

476

100,0

Employement Status The results showed that 247 study samples or 51.9% worked and 229 other samples (48.1%) did not work. Tabel 5. Distribution of Samples based on Employement Status (n=476) Employement Status Worked Unemployed Total

Total (person)

Percentage

247 229 476

51,9 48,1 100,0

Relation between Age and Selected Contraseptive Methods The results is, from 476 KB participants in the PKBRS RSUP Dr. Mohammad Hoesin Palembang for period January-December 2017, mostly aged 20-35 years. 265 participants (79.3%) chose IUD Method and 69 (20.7%) other participants chose Non-IUD methods. From Chi square statistical test, the result is p=0.000 (p<0.05) that can be concluded so there is a statistically significant relationship between age and selection of IUD contaceptive method in PKBRS RSUP Dr. Mohammad Hoesin Palembang from January to December 2017. Tabel 6. Relation between Age and Selected Contraseptive Methods (n=476) Age >35 20-35 <20 Total

Contraceptive methods IUD Non-IUD n % n % 69 61,1 44 38,9 265 79,3 69 20,7 23 79,3 2 20,7 357 75,0 119 25,0

Total n 113 334 29 476

% 100 100 100 100

p

0,000

Chi square p<0,05 Relation Between Parity History and Selected Contraseptive Methods From 476 family planning participants in the PKBRS Dr. Mohammad Hoesin Palembang January-December 2017 period, most of them had a history of parity ≥2, 71.8% of them chose the IUD Methods, whereas only 28.2% of the samples chose Non-IUD methods. From Chi square statistical test, the results is p=0.014 (p<0.05) so, can be concluded that is a statistically significant relationship between the history of parity and the selection of Contraceptive IUD methods in the PKBRS RSUP Dr. Mohammad Hoesin Palembang January-December 2017. From the results of the analysis obtained also the value of PR=0.864 (PR<1 = protective factor, risk = 1/PR) risk = 1.157 which means the opportunity to choose IUD methods in women with parity ≥2 is 0.864 times compared mothers with parity <2.

Tabel 7. Relation between Parity History and Selected Contraseptive Methods (n=476) Contraceptive methods Parity History

IUD

Non-IUD

Total

≥2

n 244

% 71,8

n 96

% 28,2

n 340

% 100

<2

113

83,1

23

16,9

136

100

Total

357

75,0

119

25,0

476

100

Chi square p <0,05

PR (lower upper) 0,864 (0,7810,955)

Relation Between Education and Selected Contraseptive Methods The results from 476 family planning participants in the PKBRS RSUP Dr. Mohammad Hoesin Palembang p January-December 2017, most of them had low education, with 71.8% of participants has low education chose the IUD methods and 28.2% chose the Non-IUD 0,01 contraceptive methods. 4 From Chi square statistical test, the value of p=0.253 (p>0.05) so, can be concluded that there is no statistically significant relationship between education and the selection of IUD contraceptive methods in the PKBRS RSUP Dr. Mohammad Hoesin Palembang January to December 2017. Tabel 8. Relation between Education and Selected Contraseptive Methods (n=476) Contraceptive methods Total Education IUD Non-IUD p n % n % n % High 48 81,4 11 18,4 59 100 151 76,6 19 100 Mid 46 23,4 7 0,253 158 71,8 22 100 Low 62 28,2 0 47 Total 357 75,0 119 25,0 100 6

Chi square p <0,05 Relation Between Employment Status and Selected Contraseptive Methods The results from 476 family planning participants in the PKBRS RSUP Dr. Mohammad Hoesin Palembang January-December 2017, most of the participants are worked, and from 247 participants who worked, those who chose IUDs were 184 people (74.7%) while the Non-IUDs were 63 (25.5%) Based on the results of the chi-square test obtained the value p=0.874 which means greater than 0.05. So it can be concluded that statistically there is no significant relationship between employement status with the selection of contraceptive methods in PKBRS RSUP Dr. Mohammad Hoesin Palembang January to December 2017. Tabel 9. Relation between Employement Status and Selected Contraseptive Methods (n=476) Contraceptive methods Total Employement IUD Non-IUD p Status n % n % n % 18 81,4 247 100 Worked 63 25,5 4 0,874 17 Unemployed 75,5 56 24,5 229 100 3 35 Jumlah 75,0 119 25,0 476 100 7

Chi square p <0,05

Multivariat Analysis In this study there are 4 variables which are considered affecting the selection of contraceptive methods in PKBRS RSUP Dr. Mohammad Hoesin Palembang January-December 2017 namely age, parity history, education, and employment status. To make a multivariate model, all of these variables must first be included into a regression test. If the results of the regression test get p<0.25 and have substance significance, then the variable can be used as a candidate of multivariate model. Tabel 10. Variabel Analysis to Selected Contraseptive Methods (n=476) Variabel

p value

Information

Age Parity History Education Employment Status

0,000 0,008 0,094 0,791

Selected Selected Selecected Not Selected

From table 10 it can be seen that age, parity history, and education have a p<0.25. While the job has p>0.25. So the variables that can be included in the multivariate model are age, parity history and education. Tabel 11. First Model of Regression Analysis (n=476) Variabel

B

Wald

Sig

Exp. (B)

Age Parity History

-0,378

9,808

0,002

0,685

95% CI Upper Lower 0,541 0,868

0,468

3,073

0,080

1,597

0,946

2,695

Education

-0,213

1,741

0,187

0,808

0,589

1,109

From table 11 above it can be seen that the history of parity and education variables have a p>0.05, so the parity history and education variables are not included in the next model. And, from table 11 above it also can be seen that the age variable is more significant related to the selection of contraceptive methods when compared with parity history and education (p=0,02). Next, a binary regression analysis test will be conducted to see which age variables have the most influence on the selection of contraceptive methods. Tabel 12. Last Model of Regression Analysis (n=476) Usia

B

>35

Wald

Sig

14,845

0.001

Exp. (B)

95% CI Upper Lower

20-35

0,894

14,459

0,000

2,449

1,543

3,886

<20

0,450

3,230

0,072

2,444

0,922

6,479

From table 23 above it is found that the subject aged between 20-35 have an Exp (B) value of 2,449. So the 20-35 aged is the most influential variable in the selection of IUD contraceptive methods.

4.

Discussion

Factors that affecting the selected contraceptive methods Age acts as an intrinsic factor in relation to the selection of contraseptive methods. The age of a woman is related to organ structure, physiological function, biochemical composition and hormonal system. This difference in physiological function, biochemical composition, and hormonal system in an age period can be the basis for the selection of contraceptive needed10. The results of this study show that 334 of the 476 family planning participants aged between 20-35 years, and 265 participants or 79.3% of them chose the IUD methods. From the results of the Chi square statistical test, the value of p=0.000 (p<0.05) that can be concluded statistically there is a significant relationship between age and the selected contaseptive methods. This is in line with anothers research which shows that age variables show a significant effect on the use of IUDs11. Younger women tend to use short-term contraceptive methods such as injections, pills and implants, while for older women, they tend to choose long-term contraceptives such as IUD and MOW12. The age of a woman determines the choice of contraceptive device, because a woman's age affects the function of the reproductive organs and the contraceptive goals themselves. According to Iyengar (2000) the use of IUDs is more in women with age groups less than 30 years and women who have reached the desired family size of 3 or more13. Similarly with the history of a woman's parity. The number of children can describe the hopes and desires of parents that can be used as the basis for the mindset, attitudes and behavior of the parents. Thus, the number of children owned by a married couple will give an idea of how much children they want14. In this study, results were obtained from 476 family planning participants, 340 of whom had a history of parity ≥2 with the results of the Chi square p=0.000 (p<0.05) indicating that there was a significant relationship between parity history and selected contaseptive methods. This research is in line with the anothers research which states that there is a significant relationship between the use of contraceptive methods with a group of respondents who have a small number compared with a group of respondents who have a larger number of children. And respondents who have a larger number of children are 3.9 times more likely to use contraceptive methods compared to women who have children ≤2 people14. The number of children is one of the most fundamental factors affecting the choice of contraceptive. In accordance with the concept "two children are better", BKKBN prioritizes the use of contraceptive IUDs as

long-term contraceptive methods that are effective in controlling population numbers. Mothers who have 2 children or more are encouraged to use a contraceptive IUD as a long-term contraceptive so the possibility of expecting another pregnancy is quite low. Couples between the ages of 20-35 years are recommended to use long-term contraceptives, one of which is the IUD 6. The parity history of a woman will also provide experience and knowledge in line with the increasing number of children born alive, so women can make the right decisions about contraceptive method to be chosen14. According to Purwoko (2000) the selection of contraceptive in couples of childbearing age will be influenced by the number of children owned. Couples of childbearing age who have a small number of living children tend to use short-term methods with low effectiveness, whereas in couples with more children there are many tendencies to use long-term methods with high effectiveness15. The tendency to stop fertility is owned by mothers who have large numbers of children so they tend to choose woman sterilization contraceptive methods16. A person's education influences actions and searches for causes and solutions in his life. Therefore people who receive education will tend to more easily accept new ideas that in line with family planning patterns idea and the basic pattern of contraceptive use and improving family welfare17. In this study, from 357 family planning participants who chose the IUD method, 158 of them had low education, 151 of them had mid education, and 48 of them were highly educated. From the results of the Chi square statistical test, the value of p=0.253 (p>0.05) so that can be concluded there is no statistically significant relationship between education and selected contaseptive methods. This result is in line with the research of Agustina and Nawati (2017) that obtained p value=0.151 (p>0.05) which means there is no significant relationship between education and contraceptive use18. However, this result is not in line with Pastuti and Wilopo's (2007) research which shows that there is a significant relationship between education and contraceptive use11. Mother's employment status is closely related to family income. Mother's work status can describe decision making in the family14. Women who work have an expensive time value so the opportunity to take care of children is less than women who don't work, and women who work will tend to limit the number of children19. The results of this study were obtained from 476, 247 (51.9%) samples are worked and 229 (48.1%) others did not work. From the results of the analysis using Chi square, the results obtained p=0.874 (p>0.05) so that it can be concluded that there is no statistically significant relationship between work and the selected contraceptive methods. This is in accordance with

research by Lakew et.al. (2013) which shows that there is no relation of one's employement status and the use of contraceptive methods20. This is not in line with Amiranty's (2003) study, which states that there is a relationship between employment status and contraceptive use. That working mothers have 2 times the chance to use contraception compared to mothers who do not work21. Is not line these findings with theory and other studies estimated because of RSUP Dr. Mohammad Hoesin Palembang is a type A hospital and not primary service place for family planning. In addition, family planning participants at the PKBRS RSUP Dr. Mohammad Hoesin Palembang in 2017 tends to be a post-partum participant, so the installation of contraception is not with their own will. In 2017 PKBRS RSUP Dr. Mohammad Hoesin Palembang only did long-term family planning procedures (implants, IUDs, and MOWs) so that data on the selection of contraceptive methods could not be compared to short-term contraceptive selection. In this study it was found that the variables aged 20-35 had the greatest influence in the selection of IUD contraceptive methods with an Exp(B) value of 2,449 to influence the choice of IUD contraceptive method. Age influence the contraception selection because it affects reproductive health and the purpose of one's contraception. According to Bernadus et al (2013) age over 20 years old is a time for spacing and preventing pregnancy so that contraceptive choices are more aimed at long-term contraception9. According to Hartanto (2004) the basic pattern of rational contraceptive use between the ages of 20-30 years is effective contraception but has a high ability to return fertility because at that age fertile age couples (PUS) are still willing to have children2. This is in line with Putri's research (2014) which states that at the age over 35 years old, contraception aims to stop fertility or sterility because this age group is also at risk of pregnancy and childbirth complications, with the results of research from 417 tubectomy participants in RSUP Dr. Mohammad Hoesin 2010-2012, 245 (58.8%) tubectomy participants were aged >35 years old and participants aged 20-35 were 172 (41.2%)22 Study Limitation There are several things that affect the results of this study related to the limitations of the study which includes the conditions of some damaged, incomplete and illegible medical records which also become obstacles in this study. The research design used in this study was cross sectional which caused data collection for research to be limited to data contained in the medical records.

5. Conclusion

From 476 research subjects at PKBRS RSUP Dr. Mohammad Hoesin Palembang regarding the factors that affecting the selected contraceptive methods, it can be concluded that there is a significant relationship between age (p=0,000) with the selection of contraceptive IUDs. There is a significant relationship between parity history factors (p=0.014) with the selection of contraceptive IUD with PR=0.874, which means the chance of selecting IUD methods in women with parity ≥2 is 0.864 times compared to mothers with parity <2, There is no significant relationship between education (p=0.253) and IUD contraceptive method selection, There is no significant relationship between employement status (p=0.874) with the selection of IUD contraceptive method, and age variables have the greatest influence compared to other variables with a significance value of 0.002 in the choice of contraceptive methods. It was found that women aged 20-35 may have 2,449 times affecting the choice of IUD contraceptive method.

Thanks Thank you to Dr. dr. Mgs. M. Irsan Saleh, M.Biomed and dr. Veny Larasati, M. Biomed as the supervisor. Thank you, the writer conveyed to the staff of Inst. Rawat Jalan RSUP Dr. Mohammad Hoesin Palembang who helped in data collection, as well as to all people who had helped and provided support in completing this research.

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