A Complete Guide on Garbhã„âdhã„âna-saã¡â¹âskã„âra: the Science of Vedic Family Planning
Perceptions of Contraception and Patterns of Switching Contraceptive Methods Among Family-planning Acceptors in West Nusa Tenggara, Republic of indonesia
Article information
J Prev Med Public Wellness. 2019;52(4):258-264
onePublic Wellness Science Program Studies, Faculty of Public Health, University of Indonesia, Depok, Indonesia
twoKinesthesia of Health Sciences, Syarif Hidayatullah State Islamic University, Jakarta, Indonesia
threeCenter for Wellness Enquiry, Academy of Indonesia, Depok, Republic of indonesia
4Department of Biostatistics and Population Studies, Kinesthesia of Public Wellness, University of Indonesia, Depok, Republic of indonesia
5Department of Wellness Education and Behavioral Science, Faculty of Public Health, University of Republic of indonesia, Depok, Indonesia
Corresponding author: Yuli Amran, PhD Public Wellness Scientific discipline Program Studies, Faculty of Public Wellness, Academy of Indonesia, Depok 16424, Indonesia East-mail: yuliamran80@gmail.com
Received 2018 August 23; Accustomed 2019 July four.
Abstruse
Objectives
The perceptions of family unit-planning (FP) acceptors regarding contraception influence the reasons for which they choose to switch their method of contraception. The objective of this study was to analyze the perceptions of contraception and rationales for switching contraceptive methods among female FP acceptors in West Nusa Tenggara, Indonesia.
Methods
This written report involved the analysis of secondary data from the Improve Contraceptive Method Mix study, which was conducted in 2013 by the Center for Health Research, University of Indonesia. The design of the written report was cross-exclusive. Nosotros performed 3 stages of sampling using the cluster technique and selected 4819 women who were FP acceptors in West Nusa Tenggara Province, Indonesia as the subjects of this written report. The data were analyzed using multiple logistic regression.
Results
The predominant pattern of switching contraceptive methods was switching from one non-long-term method of contraception to some other. Only 31.0% of the acceptors reported a rational pattern of switching contraceptive methods given their age, number of children, and FP motivations. Perceptions of the side effects of contraceptive methods, the ease of contraceptive employ, and the cost of the contraceptives were significantly associated (at the level of α=0.05) with rational patterns of switching contraceptive methods.
Conclusions
Perceptions amidst FP-accepting women were found to play an of import role in their patterns of switching contraceptive methods. Hence, fostering a better understanding of contraception through high-quality counseling is needed to better perceptions and thereby to encourage rational, effective, and efficient contraceptive apply.
Family unit-planning (FP) programs are intended to regulate fertility to improve maternal and child health. They tin decrease maternal, babe, and child mortality. Globally, the contraceptive prevalence rate (CPR), an indicator for FP programs, has increased significantly from 35% in 1970 to 63% in 2017. However, FP programs continue to face challenges in developing countries, including Indonesia. One of these challenges is the lack of multifariousness of available methods of contraception. In general, simply one or two methods are commonly used [ane]. Although Indonesia provides universal access to various methods of FP that are safe and reliable, following the recommendations of the International Conference on Population Evolution in Cairo [2], the use of contraception continues to be dominated by injections (32.0%) and pills (13.6%), which are not long-term methods. Only 10.vi% of the relevant population uses long-term contraception in Republic of indonesia [3].
The selection of a contraceptive method is important for FP acceptors. Because the objective of contraceptive employ is mainly to infinite out or limit pregnancies, FP acceptors should choose effective methods that prevent unwanted pregnancies. Therefore, individuals should consider their choices carefully when switching from one method of contraception to another. Many previous studies take investigated switches in contraceptive methods, emphasizing the patterns of and reasons for switching [4-vii].
Previously reported data betoken that many Indonesian FP acceptors do not show rational patterns of switching methods of contraception. A report showed that older women prefer non-long-term methods of contraception to long-term ones [8]. The Indonesian Basic Health Research study revealed that 49.iv% of women with 3 or more children tended to use non-long-term contraception [nine]. High levels of subject and control are needed when utilizing non-long-term contraceptive methods to avoid unwanted pregnancies. Of women who used a non-long-term contraceptive method for ane-3 months, 20-40% discontinued contraceptive use, which may result in unintended pregnancy [ten].
Thus, it is important that women make rational choices when switching contraceptive methods in light of changes in their historic period, number of children, and health weather condition. Such changes may affect which methods of contraception are ideal. For case, the first contraceptive method used by a adult female ≤35 years one-time might be a short-term method considering she may want to have more children. Then, after 35, it would be recommended for her to switch to a long-term or permanent method that is more effective at preventing pregnancy [11]. Women older than 35 are at a college take a chance in pregnancy and delivery; therefore, long-term or permanent methods of contraception may be preferable.
In Indonesia, no studies have notwithstanding investigated FP acceptors' rationales for switching contraceptive methods, although some studies have explored the reasons why first-time FP users may adopt a certain method of contraception. For case, the result of Indonesia Demographic and Wellness Survey (2012) prove the percentages of selection of contraceptive method and the source of data [3].
Choices to switch contraceptive methods for reasons beyond rational considerations are influenced by FP acceptors' perceptions of specific methods, including perceptions of side effects in comparison with those of their previous contraceptive method [12], the convenience of the particular method of contraception [thirteen], and perceptions relating to how it is used [fourteen]. Concerns have been raised about methods of contraception in the province of Westward Nusa Tenggara in Republic of indonesia. The CPR of West Nusa Tenggara is lower than the national average. Furthermore, the percentage of unmet need in this province is 14%, which is higher than the national level [three]. The objective of this study was to clarify perceptions of contraception amid FP-accepting women in West Nusa Tenggara, Indonesia and their rationales for switching contraceptive methods.
This study used baseline data from the Improving Contraception Method Mix (ICMM) study conducted in 2013. This was a collaborative study betwixt the Center for Communication Programme of Johns Hopkins University, the Cipta Cara Padu Foundation, and the Center for Health Research of the University of Indonesia. The ICMM study included 7500 married women of reproductive age (xv-49 years old) in Westward Nusa Tenggara by using a 3-phase cluster sampling technique. The study design was cross-sectional. The inclusion criteria for the respondents of our report were living in Due west Nusa Tenggara, beingness married, and having ever used and using contraception. Thus, we analyzed data from 4819 women who were FP acceptors. The data were nerveless through contiguous interviews with a questionnaire.
The dependent variable of this written report was the rationality of respondents' pattern of switching contraceptive methods. The criteria used to define a rational pattern of switching contraceptive methods were developed on the footing of the patterns of rational utilise of FP presented by the National Population and Family unit Planning Lath of Indonesia. Rationality in switching contraceptive methods means that the method of contraception is changed in accordance with a woman'southward historic period, number of children, and FP motivation [eleven]. The contained variables were perceptions of contraceptive methods, including perceptions of side effects, cost, ease of use, and accessibility. Individual characteristics and FP provider characteristics were analyzed as confounding variables.
This report analyzed data using univariate and bivariate analysis. These statistical analyses were followed by multiple logistic regression analyses to confirm the influence of factors related to rational patterns of switching methods of contraception.
Nosotros controlled for individual characteristics and FP provider characteristics in guild to focus on the effects of perceptions of the side effects, cost, ease of use, and accessibility of contraceptives on the likelihood of having a rational pattern of switching contraceptive methods. The first step in the multivariate analyses was to include all contained variables and to obtain odds ratios (ORs) for the main independent variables (perception-related variables). The 2nd stride was to control the confounding variables. Nosotros excluded the confounders i past one, and then we observed the changes in the ORs of the perception-related variables compared with their original values. Past controlling the misreckoning variables, nosotros obtained adjusted odds ratios (aORs) for the perception-related variables. The analyses ended if individual characteristics and family planning provider were non the confounder variables.
Ethics Statement
This study was approved past the Ethical Review Committee of the Faculty of Public Health, University of Indonesia (329/UN2.F.10/PPM.00.02/2016).
Of the 4819 women of reproductive historic period, 2196 were FP acceptors over 35 years of age, of whom eighty.9% expressed the motivation to space their pregnancies (Tabular array i). Meanwhile, among the 3232 FP acceptors who had 2 or more than children, 83.4% expressed the motivation to space their pregnancies.
Characteristics, FP motivations, and patterns of switching contraceptive methods amid female FP acceptors in Westward Nusa Tenggara, Republic of indonesia, 2013
As also shown in Table one, regardless of age and number of children, among women with the FP motivation of spacing their pregnancies or limiting the number of children, the predominant tendency was to switch from a not-long-term contraceptive method to another non-long-term contraceptive method. In other words, differences in women's circumstances led to no primal departure in the blueprint of switching contraceptive methods. Among women who were FP acceptors, only 31.0% reported a rational blueprint of switching contraceptive methods.
Table 2 presents the distribution of women who were FP acceptors, based on their perceptions of their methods of contraception. Women who perceived that their contraceptive method had no side furnishings tended to have a rational pattern of switching contraceptive methods (33.ii%), unlike those who reported that their method of contraception had side effects (eighteen.8%). Women who reported that contraceptives were not easy to use were more than probable to show a rational pattern of switching contraceptive methods than those who stated that contraceptive use was like shooting fish in a barrel. In addition, women who reported that the toll of their method of contraception was moderate tended to have a rational pattern of switching contraceptive methods.
Patterns of switching contraceptive methods according to perceptions of contraception among female family unit-planning acceptors in West Nusa Tenggara, Indonesia, 2013
Furthermore, Table iii shows that rational patterns of switching contraceptive methods were more common amidst women who had a higher education (45.five%), made decisions with their husbands (32.vi%), and received information on contraception from an FP provider (32.four%).
Patterns of switching contraceptive methods according to knowledge level, private characteristics, and family unit-planning (FP) provider characteristics among female FP acceptors in West Nusa Tenggara, Indonesia, 2013
Multiple logistic regression analyses were performed to determine the relationship betwixt perceptions of contraception and the likelihood of having a rational pattern of switching contraceptive methods. When individual characteristics and FP provider variables were controlled, perceptions of the side effects, toll, and ease of apply of contraceptives were significantly associated (α=0.05) with a rational blueprint of switching contraceptive methods.
Compared to women who perceived the toll of contraceptives to be free, those who perceived that the cost of contraceptives from a private provider was high were 1.65 times more than likely (95% confidence interval [CI], 1.fourteen to ii.39) to have a rational pattern of switching contraceptive methods. Similarly, women who perceived the cost of contraceptives from a private provider to be moderate were 1.72 times more likely (95% CI, 1.29 to 2.30) to study a rational pattern of switching contraceptive methods. Meanwhile, women who perceived that the price of contraceptives from a government provider was moderate were 0.76 times less likely (95% CI, 0.62 to 0.95) to take a rational design of switching contraceptive methods. In improver, women who perceived contraceptive use to be like shooting fish in a barrel were 1.33 times (95% CI, 1.11 to one.58) more probable to accept a rational pattern of switching contraceptive methods than those who perceived contraceptive employ equally hard. Additionally, perceptions of the side effects of the contraceptive method had a significant impact on the likelihood of women to report a rational method of switching contraceptive methods (aOR, one.62; 95% CI, 1.43 to1.83) (Table four).
Associations between perceptions of contraceptive methods and the likelihood of having a rational blueprint of switching contraceptive methods, decision-making for individual characteristics and FP provider characteristics, among female person FP acceptors in West Nusa Tenggara, Indonesia, 2013
The results of this study indicate that moving from one non-long-term method of contraception to another non-long-term method was the predominant pattern of switching contraceptive methods. This result is similar to that obtained past a written report in southeastern Federal democratic republic of ethiopia [15], which found that 29.4% of participants had switched their contraceptive method, of whom 49.1% inverse from pills to injections. In the U.s., it was also constitute that 42.half dozen% of married women had switched their contraceptive method from pills to condoms [16]. In fact, it appears that not all FP acceptors are willing to switch. Women older than 35 and those who have two or more children have motivations to limit the number of their children, significant that high-effectiveness contraceptives are recommended for them. Therefore, a long-term method of contraception is an appropriate choice for such women [11]. However, in reality, women prefer to choose other non-long-term methods of contraception instead of long-term ones. Nosotros plant that only one-3rd of FP-accepting women in W Nusa Tenggara, Indonesia had a rational pattern of switching their contraceptive method relative to their historic period, number of children, and FP motivation.
Our study indicated that perceptions of the side effects of methods of contraception were significantly associated with switching contraceptive methods, co-ordinate to age, number of children, and FP motivation. Of the 4 perception-related variables measured in this study, perceptions of the side effects of contraception were the most influential factor in women switching contraceptive methods. Mansour [xiii]'s study showed that a minimum bear upon on health and wealth was key for the selection of a contraceptive method. Thus, improving FP acceptors' understanding of the side effects of diverse methods of contraception is needed to assist them consider which method is most appropriate for them and to enable them to rationally switch contraceptive methods.
This study too found that perceptions of the cost of contraceptives also influenced the pattern of switching contraceptive methods among FP acceptors. They might have had the perception that private providers offer high-quality services and can provide contraceptive methods appropriate for their need with fewer side effects. Therefore, FP acceptors preferred to obtain contraception from a private provider, although doing so is a more expensive option than obtaining contraception from a authorities provider. Our report is supported by the findings of Korachais et al. [17], who concluded that the demand for contraception was not cost-sensitive among users in low-income and middle-income countries. The present report also found that the likelihood of having a rational design of switching contraceptive methods was higher amongst women who had specific perceptions nearly the cost of contraceptives obtained from private providers.
This study also analyzed the perceptions of contraceptive utilize. Women tend to switch to methods of contraception that are easy to use [4,13,fourteen]. However, methods of contraception that are easy to use may be non effective for fertility reduction. Our study found that FP acceptors believed that non-long-term contraceptive methods, such as injections and pills, were like shooting fish in a barrel to employ. Parajuli et al. [xiv] found a similar result, last that oral contraceptive pills were felt to be easier to employ. Contraceptive methods perceived equally not easy to utilize included those requiring an invasive intervention or surgery, such as intrauterine devices, implants, and sterilization, which prompted fear amidst FP acceptors. However, we plant that FP acceptors who perceived that their method of contraception was difficult to use nevertheless were more probable to have a rational pattern of switching contraceptive methods. This may have been because women understood which method of contraception was virtually appropriate for their nowadays condition. FP acceptors with a solid understanding of contraceptives tend to be loyal to their selected method [xviii]. More information is needed on FP acceptors' rationales for selecting a method of contraception, and knowledge about how contraceptive methods are used is needed to assistance reduce fear regarding sure contraceptive methods.
In determination, our study establish a high prevalence of irrational patterns of switching contraceptive methods. The predominant design among women who were FP acceptors was to switch from ane not-long-term contraceptive method to another. This may have been because the majority of women had the motivation to space out their pregnancies, not to limit their number of children. Those participants considered non-long-term contraceptive methods to be the best options. Perceptions of the side effects of contraceptive methods were among the primary factors contributing to the likelihood of a rational pattern of switching contraceptive methods. Hence, information on side effects must be disseminated to amend the rationality with which FP acceptors in Indonesia choose methods of contraception.
Nosotros are grateful to the Johns Hopkins Center for Advice Program and the Centre for Wellness Inquiry, University of Republic of indonesia for their permission, technical assist, and help in finalizing the manuscript. This study was supported past the United States Agency for International Evolution (USAID) and the Department Foreign and Trade (DFAT) under the Improving Contraceptive Method Mix (ICMM) project, managed by the Johns Hopkins Centre for Communication Program. The authors likewise express special thank you to Mrs. Yunita Wahyuningrum, S.Sos. M.Si, and Dr. Douglas Storey, PhD for their support in the implementation of this study.
References
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Table one.
Characteristics, FP motivations, and patterns of switching contraceptive methods amid female person FP acceptors in West Nusa Tenggara, Republic of indonesia, 2013
| Characteristics | Motivation, n (%) | Switching blueprint, % | ||||
|---|---|---|---|---|---|---|
| N→L | L→L | Fifty→Due north | Northward→Northward | |||
| Age (y) | ||||||
| ≤35 | Spacing pregnancies | 2460 (93.viii) | five.8one | 6.viii | 3.01 | 84.6one |
| Limiting number of children | 163 (6.two) | 19.0one | 11.seven1 | v.v | 63.8 | |
| >35 | Spacing pregnancies | 1777 (80.9) | vii.one1 | 9.31 | 10.7 | 72.nine |
| Limiting number of children | 419 (19.one) | 18.91 | 20.3one | 8.1 | 52.seven | |
| No. of children (northward) | ||||||
| <two | Spacing pregnancies | 1542 (97.2) | 2.61 | two.viiii | ane.61 | 87.nineone |
| Limiting number of children | 45 (2.viii) | viii.ninei | 11.11 | 4.4 | 75.6 | |
| ≥2 | Spacing pregnancies | 2695 (83.4) | viii.51 | 7.81 | 8.8 | 75.0 |
| Limiting number of children | 537 (16.six) | nineteen.71 | 18.41 | seven.vi | 54.two | |
FP, family-planning; N, non-long-term contraceptive method; L, long-term contraceptive method.
Table 2.
Patterns of switching contraceptive methods according to perceptions of contraception among female person family-planning acceptors in Due west Nusa Tenggara, Indonesia, 2013
| Independent variable | Total (northward=4819) | Pattern of switching contraceptive methods, % | |
|---|---|---|---|
| Rational | Irrational | ||
| Perception of the side effects of contraceptives | |||
| Do non be | 4265 | 33.2 | 66.eight |
| Be | 554 | 18.8 | 81.2 |
| Perception of the cost of contraceptives | |||
| Expensive | 1098 | 30.0 | 70.0 |
| Moderate | 2082 | 32.ix | 67.1 |
| Free | 1639 | 31.1 | 68.9 |
| Perception of ease of contraceptive employ | |||
| Piece of cake | 4178 | 30.nine | 69.one |
| Not easy | 641 | 36.3 | 63.7 |
| Perception of the accessibility of contraceptives | |||
| Easy | 4311 | 31.4 | 68.half dozen |
| Non like shooting fish in a barrel | 508 | 33.one | 66.ane |
Table 3.
Patterns of switching contraceptive methods according to knowledge level, individual characteristics, and family-planning (FP) provider characteristics among female person FP acceptors in Westward Nusa Tenggara, Republic of indonesia, 2013
| Variables | Total (n = 4819) | Pattern of switching contraceptive methods, % | |
|---|---|---|---|
| Rational | Irrational | ||
| Individual characteristics | |||
| Cognition level | |||
| High | 1932 | 29.6 | 70.4 |
| Low | 2887 | 32.9 | 67.ane |
| Education | |||
| High | 231 | 45.v | 54.5 |
| Eye | 884 | 39.4 | 60.half dozen |
| Low | 3704 | 28.9 | 71.ane |
| Socioeconomic status | |||
| Quintile v (richest) | 455 | 24.0 | 76.0 |
| Quintile 4 | 682 | 27.1 | 72.ix |
| Quintile 3 | 1120 | 31.ane | 68.9 |
| Quintile 2 | 1128 | 32.iv | 67.6 |
| Quintile one (poorest) | 1434 | 35.ix | 64.1 |
| Decision-making | |||
| Hubby and married woman | 2091 | 32.vi | 67.four |
| Married woman only | 2728 | 30.8 | 69.2 |
| FP provider | |||
| Provider type | |||
| Regime | 1692 | 31.0 | 69.0 |
| Private | 1651 | 31.half dozen | 68.four |
| Other | 1476 | 32.2 | 67.8 |
| Information from provider | |||
| Yes | 2320 | 32.four | 67.6 |
| No | 2490 | 30.8 | 69.2 |
| Recommendation | |||
| Midwife | 1448 | 31.0 | 69.0 |
| Dr. | 141 | 31.two | 68.8 |
| Other | 3230 | 31.9 | 68.1 |
Tabular array four.
Associations between perceptions of contraceptive methods and the likelihood of having a rational pattern of switching contraceptive methods, controlling for private characteristics and FP provider characteristics, amid female FP acceptors in West Nusa Tenggara, Indonesia, 2013
| Independent variable | aOR (95% CI)ane |
|---|---|
| Perception of the side effects of contraceptives | |
| Do non exist | one.62 (one.43, 1.83)two |
| Exist (reference) | 1.00 (reference) |
| Perception of cost of contraceptives | |
| Expensive from government provider | 0.97 (0.73, 1.30) |
| Expensive from individual provider | 1.65 (ane.14, two.39)two |
| Expensive from other provider | ane.10 (0.78, i.56) |
| Moderate from authorities provider | 0.76 (0.62, 0.95)ii |
| Moderate from private provider | 1.72 (1.29, 2.30)ii |
| Moderate from other provider | i.28 (i.00, ane.65)ii |
| Complimentary (reference) | 1.00 (reference) |
| Perception of ease of contraceptive use | |
| Piece of cake | 1.33 (i.11, 1.58)2 |
| Not easy (reference) | 1.00 (reference) |
| Perception of the accessibility of contraceptives | |
| Easy | i.xx (0.98, i.48) |
| Not easy (reference) | one.00 (reference) |
FP, family-planning; aOR, adapted odds ratio; CI, confidence interval.
Source: https://www.jpmph.org/journal/view.php?viewtype=pubreader&number=2036
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