The role of decision-making pattern on the use of long-acting and permanent contraceptive methods among married women in Indonesia

Women alone modern contraceptive use decision making and its correlates, evidence from PMA CS 2021 survey

BACKGROUND

Women alone contraceptive decisions making has become one of the top burring public health agenda. Despite Contraceptive method options are available and accessible, contraceptive prevalence rate (CPR) in Ethiopia is not far beyond 41%. Evidences showed that the freedom of women to choose the contraceptive method they desired to use is one of the potential determinants for the sluggish pace of increase in contraceptive usage. In this era of sustainable development, determining the level of women own contraceptive use decision making and identifying its correlates is very critical for the ministries and relevant partners' effort in tracking the achievement of Sustainable Development Goal (SDG) 5.2 by providing actionable evidence through informed decision-making with the aim of improving contraceptive uptake; reducing maternal mortality and improve newborn health.

METHODS

Nationally representative cross-sectional data from Performance Monitoring for Action (PMA) 2021 was used in this study. The sample was restricted among2446 married women who have been using or most recently used modern contraceptive method. Cell sample size adequacy was checked using a chi-square test. Frequency was computed to characterize the study participants. Multilevel binary logistics regression was used to identify factors associated with women own contraceptive use decision making. The findings were presented in a form of frequencies, percentage and as an odds ratio using 95% confidence interval. A p-value of 0.05 was used to declare significance.

RESULTS

This study revealed that higher than one in two women (59.49%; 95% CI: 57.7-61.38%) decide their contraceptive use by themselves. What is more interesting is that 1 in 16 women (6.06%) reported that they did not participated in their contraceptive use decision-making.-. Women aged 20 to 24 years; (AOR: 2.51 (1.04, 4.45)), women who stayed10 and above years in marriage; (AOR: 1.73 (1.08, 2.77)), whose husband and/or partner age is 41 and above years; (AOR: 2.14 (1.06, 4.31)) and those who obtained contraceptive method they desired; (AOR: 2.49 (1.36, 4.57)) had higher odds of deciding their current and/or recent contraceptive use by their own. On the other hand, women mixed feeling if they became pregnant at the time of the survey; (AOR: 0.6 (0.44, 0.91)), women who started using contraceptive at younger age, 19 to 24; (AOR: 0.6 (0.44, 0.81)), those who use long acting and/or permanent method; (AOR: 0.54 (0.41, 0.71)) and those married at younger age, 10 to 19 years; (AOR: 0.28 (0.09, 0.86)) had lower odds of independently deciding their current and/or most recent contraceptive use.

CONCLUSION

59% of women independently decide their contraceptive use which calls up on further improvement to enable each woman to decide by their own, with directing special focus for the 6.06% of women who reported no say in their contraceptive use decision. Activities targeting on enabling women to use the method they preferred, spacing their pregnancy, encouraging women to discuss with their husband on the time and type of contraceptive method they used, advocating and promoting marriage at least to be at the minimum age as indicate by the law and maintain the marriage duration as much as longer are hoped to improve women alone contraceptive use decision making to the fullest.

The choice of delivery place in Indonesia: Does home residential status matter?

Background

To care for their health needs, women in Indonesia who live with their parents or in-laws frequently lose their independence, including the choice of delivery place.

Aim

The study aimed to analyze the effect of home residential status on the choice of delivery place in Indonesia.

Methods

The study design was a cross-sectional study. The study employed secondary data from 2017 Indonesian Demographic and Health Survey (IDHS). The research included 15,357 women aged 15-49 with live births in the last five years. Meanwhile, the study used place of delivery as an outcome variable and home residential status as an exposure variable. Moreover, the research employed nine control variables: type of residence, age group, education level, employment status, marital status, parity, wealth status, health insurance, and antenatal care visits-the final analysis using binary logistic regression.

Findings

The result shows that women with home residential status in the alone category were 1.248 times more likely than those in the joint category to choose to give birth to healthcare facilities (AOR 1.248; 95% CI 1.143-1.361). In addition to home residential status, the study also found seven control variables to have a relationship with the choice of place of delivery. The seven control variables were the type of residence, age group, education level, parity, wealth status, health insurance, and antenatal care.

Conclusion

The study concluded that home residential status affects the choice of delivery place in Indonesia.

Influence of internet, mobile phone use, and sociodemographic factors on women's knowledge and attitude towards contraception in Indonesia

OBJECTIVE

Rapid population growth has been a problem in Indonesia for several decades. One of the reasons for this phenomenon is limited knowledge of reproductive health and proper contraception.

METHODS

. The use of mobile phones and the internet has made it easier to access health information. This study aimed to determine the influence of the internet, mobile phone use, and sociodemographic factors on Indonesian women's knowledge of and attitudes toward contraception.

METHODS

The present study used secondary data from the 2017 Indonesian Health and Demographics Survey. Altogether, 49,627 women participated in this study. Descriptive statistics were performed, and bivariate analysis using the chisquared test was performed to measure the association between variables.

RESULTS

Knowledge about the ovulation cycle and contraception was positively associated with mobile phone ownership, frequent internet use, higher wealth index, reading printed media, listening to the radio, watching the television, higher educational level, and older age. The use and intention of contraception were positively associated with lower wealth index, watching television at least once a week, primary-secondary educational level, rural residence, and older age. Thus, acquisition of knowledge does not necessarily translate into implementation of contraceptive.

METHODS

, since there might be certain digital and social barriers.

CONCLUSION

Access to the internet and mobile phones as well as certain sociodemographic factors have contributed to an increase in women's knowledge about contraception, but not necessarily in their knowledge regarding the use of contraception.

Women’s decision-making power regarding family planning use and associated factors in Ethiopia: A systematic review and meta-analysis

Objective:

Although emphasis is placed on women’s decision-making power regarding family planning use in Ethiopia, the utilization of contraceptives is low. There are studies conducted in different parts of the country on women’s decision-making power regarding family planning use; however, there are inconsistent findings. Thus, this study aimed to determine the pooled prevalence of women’s decision-making power regarding family planning use and associated factors in Ethiopia.

Methods:

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to develop the systematic review and meta-analysis. All observational studies were retrieved from online databases, including PubMed, CINAHL, Google Scholar, African Journal Online and gray literature. The data search was performed from 1 December to 16 May 2022. The quality of the studies was critically assessed using the Joanna Briggs Institute checklist. Heterogeneity among studies was examined using the I2 statistic. RevMan version 5.3 and STATA version 14 software were used for analysis.

Results:

A total of 852 studies were retrieved, and 8 studies were included in the final meta-analysis. The pooled prevalence of women’s decision-making power regarding family planning use was 57 (95% confidence interval: 37, 77). Good knowledge of family planning methods (odds ratio: 2.46, 95% confidence interval: 1.65, 3.67), a positive attitude toward family planning methods (odds ratio: 2.04, 95% confidence interval: 1.3, 3.2), and having primary or higher education (odds ratio: 9.76, 95% confidence interval: 4.36, 21.99) were associated with increased odds of women’s decision-making power regarding family planning use.

Conclusion:

Nearly three in five married women made decisions regarding family planning use in Ethiopia. Women with good knowledge of family planning methods, a positive attitude toward family planning methods, and women having primary or higher education were associated with increased odds of women’s decision-making power regarding family planning use.

Associations between Contraceptive Decision-Making and Marital Contraceptive Communication and use in Rural Maharashtra, India

Women's contraceptive decision-making control is crucial for reproductive autonomy, but research largely relies on the Demographic and Health Survey (DHS) measure which asks who is involved with decision-making. In India, this typically assesses joint decision-making or male engagement. Newer measures emphasize female agency. We examined three measures of contraceptive decision-making, the DHS and two agency-focused measures, to assess their associations with marital contraceptive communication and use in rural Maharashtra, India. We analyzed follow-up survey data from women participating in the CHARM2 study (n = 1088), collected in June-December 2020. The survey included the DHS (measure 1), Reproductive Decision-Making Agency (measure 2), and Contraceptive Final Decision-Maker measures (measure 3). Only Measure 1 was significantly associated with contraceptive communication (adjusted odds ratio [AOR]: 2.75, 95 percent confidence interval [CI]: 1.69-4.49) and use (AOR: 1.73, 95 percent CI: 1.14-2.63). However, each measure was associated with different types of contraceptive use: Measure 1 with condom (adjusted relative risk ratio [aRRR]: 1.99, 95 percent CI: 1.12-3.51) and intrauterine device (IUD) (aRRR: 4.76, 95 percent CI: 1.80-12.59), Measure 2 with IUD (aRRR: 1.64, 95 percent CI: 1.04-2.60), and Measure 3 with pill (aRRR: 2.00, 95 percent CI: 1.14-3.52). Among married women in Maharashtra, India, male engagement in decision-making may be a stronger predictor of contraceptive communication and use than women's agency, but agency may be predictive of types of contraceptives used.

Factors associated with use of long-acting reversible and permanent contraceptives among married women in rural Kenya: A community-based cross-sectional study in Kisii and Kilifi counties

Long-acting and permanent contraceptive methods (LAPM) are effective and economical methods for delaying or limiting pregnancies, however they are not widely used. The Kenya government is promoting the use of modern methods of family planning through various mechanisms. This study aimed to determine the prevalence and factors associated with the use of LAPM among married women of reproductive age in targeted rural sub-counties of Kilifi and Kisii counties, Kenya. Baseline and end line Data from a program implemented on improving Access to Quality Care and Extending and Strengthening Health Systems (AQCESS) in Kilifi and Kisii counties of Kenya were used. Multi-stage sampling was used to sample 1117 and 1873 women for the end line and baseline surveys, respectively. Descriptive analysis was used to explore the respondents' characteristics and use of LAPM on a self-weighted samples. Univariable and multivariable binary logistic regression models using svy command were used to assess factors associated with the use of LAPM. A total of 762 and 531 women for the baseline and end line survey, respectively were included in this study. The prevalence of use of LAPM for baseline and end line survey were 21.5% (95% CI: 18.7-24.6%) and 23.2% (95% CI: 19.6%-27.0%), p-value = 0.485. The use of LAPM in Kisii and Kilifi counties was higher than the national average in both surveys. The multivariable analysis for the end line survey showed having 3-5 number of children ever born (aOR = 2.04; 95% CI: 1.24-3.36) and future fertility preference to have another child (aOR = 0.50; 95% CI: 0.26-0.96) were significantly associated with odds of LAPM use. The baseline showed that having at least secondary education (aOR = 1.93; 95%CI: 1.04-3.60), joint decision making about woman's own health (aOR = 2.08; 95%CI: 1.36-3.17), and intention to have another child in future (aOR = 0.59; 95%CI: 0.40-0.89) were significantly associated with the use of LAPM. Future fertility preference to have another child was significantly associated with the use of LAPM in the two surveys. Continued health promotion and targeted media campaigns on the use of LAPM in rural areas with low socioeconomic status is needed in order to improve utilization of these methods. Programs involving men in decision making on partner's health including family planning in the rural areas should be encouraged.

Women’s Decision-Making Power on Modern Family Planning Use and Its Associated Factors in Northwest Ethiopia

Introduction

Poor decision-making power on family planning among married women is a public health concern. Despite this, there is a scarcity of research done on decision-making power of family planning use as one of their basic human rights. The study is aimed at determining the magnitude of married women's decision-making power on family planning use and its associated factors.

Methods

This was a community-based cross-sectional study that was conducted on married women from May, 01-30/2021. A multistage systematic random sampling technique was applied to select 620 eligible study participants. The study used semi-interviewer questionnaires to collect data, and the collected data were entered into EpiInfo version 3.7.2 and then exported to SPSS version 20 for analysis. Bivariate and multivariable logistic regression analyses were used. The strength of associations of variables was described by using odds ratio, 95% confidence level, and P values less than 0.05.

Results

A total of 620 women were interviewed with 98% of the response rate. Overall, married women's decision-making power on family planning was 440 (71.0%). Odds of decision-making power on family planning use were higher among women who have primary education (AOR = 11.31, CI: 4.90-26.09) and secondary and above (AOR = 6.99, CI: 3.89-12.56) as compared with those who have no education. Husbands with secondary and above educational level (AOR = 3.27, CI: 1.58-6.78), having good knowledge about family planning use (AOR = 2.41, CI: 1.48-3.95) and having a good attitude towards family planning (AOR = 6.59, CI: 4.01-10.75), had higher odds of decision-making power on family planning.

Conclusion

Women's educational status, knowledge, and attitude increased the odds of decision-making power on family planning. Therefore, the authors recommend awareness creation on family planning considering lower educational level as a priority to improve women's decision-making power.

The use of long-acting and permanent contraceptive methods (LAPMs) among women who have completed childbearing in Indonesia: does informed choice matter?

OBJECTIVES

This study examined factors associated with long-acting and permanent contraceptive methods use among married women who completed childbearing in Indonesia.

METHODS

Data were extracted from the 2017 Indonesia Demographic and Health survey. Subjects of this study comprised 12,790 (weighted) married women aged 15-49 years who completed their childbearing and used modern contraceptive methods. Logistic regression adjusted for complex sample was used to assess factors associated with LAPMs use among women in Indonesia.

RESULTS

Only 28% of the participants used long-acting and permanent contraceptive methods. Older women, higher number of living children, higher educational level, informed choice, and living in urban areas were associated with higher likelihood of adopting long-acting and permanent contraceptive methods. Women who received comprehensive counselling on contraceptive methods were more likely to adopt long-acting and permanent contraceptive methods compared with women who did not receive comprehensive counselling on contraceptive methods (AOR = 1.23; 95% CI: 1.07-1.41). Women who attained secondary (AOR = 1.31; 95% CI: 1.14-1.50) or higher (AOR = 2.36; 95% CI: 1.91-2.91) educational level were more likely to use long-acting and permanent contraceptive methods compared to women with primary education or less. The use of long-acting and permanent contraceptive methods was higher among women aged 35-49 (AOR = 1.41; 95% CI: 1.24-1.61) and women who have three or more living children (AOR = 1.75; 95% CI: 1.57-1.96) than their counterparts.

CONCLUSION

The use of long-acting and permanent contraceptive methods was still low, even though there were more than half of women completed childbearing. The informed choice had a key role in improving long-acting and permanent contraceptive methods uptake. Training programs on contraceptive counselling for health providers and improving couple's awareness on the effectiveness of long-acting and permanent contraceptive methods were suggested to increase long-acting and permanent contraceptive methods adoption.

Pattern and Determinant of Contraceptive Use among Women in Indonesia from 2007 to 2017: Evidence from Demographic and Health Survey

Background: Modern contraceptives are proven as the most effective birth control methods. However, it was a change in the pattern of modern method use in Indonesia to traditional. Objectives: This study investigated the pattern of contraceptive use and its determinant in Indonesia between 2007 and 2017. Methods: The study employed data from the Indonesian Demographic and Health Survey (IDHS) 2007, 2012, and 2017. Eligible participants included all women aged 15–49 who were married/living together with a partner. The dependent variable was contraceptive method use categorized as long-term, short-term, and traditional. Weighted pooled logistic regression analysis was applied to determine the shifting patterns of the independent variables related to contraceptive use over time. Results: The trend of contraceptive use in Indonesia has shifted over the three periods of the IDHS. During the three survey periods, contraceptive use was still dominated by short-term contraception, although over the last five years, the proportion has shown a decline of around 9%. Traditional contraceptive adoption followed the same patterns as long-acting reversible contraception (LARC), although having a smaller prevalence. Education level was significantly unassociated with the use of the traditional method at the beginning of the observation. However, more educated and knowledgeable women about contraceptive methods were more likely to use traditional contraceptives, switched from long-acting use following the next five and ten years. Long-term methods were no longer significantly more common among women in Java and Bali after five and ten years; the likelihood of using traditional methods in Java and Bali was growing. Conclusion: This study showed that contraceptive use and determinants were always dynamic over time. Therefore, family planning strategies and policies should adapt accordingly. Giving an understanding of contraceptive methods' benefits and risks through adequate method information is encouraged to prevent contraceptive dropout or switch to less-effective methods.

The determinant of health insurance ownership among pregnant women in Indonesia

BACKGROUND

Health insurance ownership is one indicator of the readiness of pregnant women for the delivery process. The study aimed to analyze the determinants of health insurance ownership among pregnant women in Indonesia.

METHODS

The study population was pregnant women in Indonesia. The study involved 2542 pregnant women in Indonesia. The variables analyzed included type of place of residence, age group, education level, employment status, marital status, parity, wealth status, and know the danger signs of pregnancy. In the final step, the study employed binary logistic regression to explain the relationship between health insurance ownership and predictor variables.

RESULTS

The results show that pregnant women with higher education were 3.349 times more likely than no education pregnant women to have health insurance. Pregnant women with wealth status in the middle category were 0.679 times the poorest pregnant women to have health insurance. Meanwhile, the richest pregnant women had 1.358 times more chances than the poorest pregnant women to have health insurance. Grande multiparous pregnant women were 1.544 times more likely than primiparous pregnant women to have health insurance. Pregnant women who know the danger signs of pregnancy were 1.416 times more likely than pregnant women who don't see the danger signs of pregnancy to have health insurance.

CONCLUSIONS

The study concluded that four variables, including education level, wealth status, parity, and knowledge of the danger signs of pregnancy, were significant determinants of health insurance ownership in Indonesia.

The association between recent sexual activity and the use of modern contraceptive methods among married/cohabiting women in Indonesia

Background: Modern contraceptive methods are considered more reliable for preventing and spacing pregnancy than traditional methods in sexual activity. The study aimed to analyze the association between recent sexual activity and the use of modern contraceptive methods among married/cohabiting women in Indonesia.

Design: The samples used were married/cohabiting women aged 15-49 years old. The sample size was 34,467 women. The variables analyzed included modern contraceptive use, recent sexual activity, age groups, marital status, education level, and wealth status. Analysis using multinomial logistic regression.

Results: It was found that women who were sexually not active last 4 weeks had the likely to use modern contraceptive non-LARC (long-acting reversible contraceptives) 0.416 times compared to women who were sexually active last 4 weeks. Women who were sexually active last 4 weeks were more likely to use modern contraceptive LARC 0.535 times than women who were sexually active last 4 weeks. The results of this analysis inform that women who are sexually active last 4 weeks have a higher possibility to use modern contraceptives, both non-LARC and LARC types.

Conclusions: Based on the results of the research analysis it could be concluded that recent sexual activity was associated with modern contraceptive use among married/cohabiting women in Indonesia.