FACTORS AFFECTING THE SELECTION OF PILL AND INJECT

CONTRACEPTION TOOLS
Elis F.Sapury
S1 Ilmu Keperawatan STIKes Bina Sehat PPNI Mojokerto

ABSTRACT

Contraception is an effort made to prevent pregnancy, these efforts can be temporary or

permanent. Types of contraception often make people confused to determine the choice of
contraception that is suitable for use and many factors play a role in determining the choice of
contraception. Factors that influence acceptors choosing pill and injection contraception include, such
as knowledge, level of education, economic status, parity, occupation, age, husband's support, beliefs
or religion and culture. The purpose of this study is to identify factors that influence the selection of
contraceptive pills and injections. The research method is a literature study. The data source that the
researcher will use is the secondary data source. The results showed the use of contraceptives
according to education level, namely SLTA (45.5%), according to the economic status of high
socioeconomic (54.8%), according to parity of 2 to 3 children (60.3%), according to work, namely
self-employed (34.5%), according to age, namely age 20-35 years (72.7%), according to the husband's
support factor, the husband supports the KB acceptor (95.4%), according to trust and culture, ie those
who do not believe in beliefs and culture (90%). It can be concluded that the most influential factors
in the selection of contraceptive pills and injections are the factors of husband support, trust and
culture, age, parity, economic status, education, and education factors.

Keywords: Contraception, education, economic status, parity, occupation, age, husband support,
trust and culture.

INTRODUCTION In East Java, the coverage of active

Indonesia is a country with a dense
population. The birth rate restriction program
in Indonesia is known as the family planning
program or commonly abbreviated as KB.
Family planning (KB) is an effort made to
assist individuals or couples in getting the
desired birth, adjusting the interval between
pregnancies, determining the number of
children in the family and avoiding unwanted
births. In order to achieve this, several ways
have been made to prevent or delay pregnancy,
including the use of contraception.
According to the BKKBN, since the last
three years, the prevalence of contraception in
Indonesia has fluctuated. In 2016, the
prevalence of contraception in Indonesia was
59.39%. This figure decreased to 58.70% in
2017 and slightly increased to 58.73% in 2018.
Meanwhile, the RPJMN target to be achieved
in 2019 is 66%. Differences in the percentage
of contraceptive prevalence can be seen
between regions in Indonesia. When viewed
according to the highest active Kb province
was in Bengkulu province at 71.15% and the
lowest was in Papua province at 25.73%
(Indonesian Ministry of Health, 2019).
family planning is 65.69%, with the highest
family planning coverage in Pasuruan district
(15.4%) and the lowest in Malang (Depkes,
2016). Data from the health office of
Mojokerto Regency shows that the number of
PUS in 2017 is 186,916, the number of new
family planning participants is 17,458 (9.3%)
and the number of active family planning
participants is 161,085 (86.2%). Active family
planning participants in Mojokerto Regency in
2017 chose the most long-term contraceptive
method (MKJP) for the IUD type, amounting
to 7.3%, while the non-MKJP family planning
most preferred was the injection type at 66.4%
and the pill at 12.5% . The new FP participants
in Mojokerto Regency in 2017 chose the most
long-term contraceptive method (MKJP) for
the IUD type by 8%, while the New Non-
MKJP family planning that was mostly chosen
was the injection type with 62.4% and the pill
for 16.7%. Based on the re-registration data
for family planning in the work area of
​ ​ Puskesmas Puri, Mojokerto Regency, the
achievement of active family planning in 2019
was 10,892 participants with details of each
method, 1,785 pills (16.3%) acceptors, and
7,355 injection contraceptives (67.5 %)
acceptors.
 A preliminary study conducted in the
work area of ​ ​ Puskesmas Puri, Mojokerto
Regency on November 20-21 2019, found 6
couples of childbearing age, 3 people using
pill contraception and 3 other people using
injection contraception. The main reason that
supports the use of the contraceptive pill and
injection contraceptive is because according to
them it does not interfere with the husband and
wife relationship, does not cause abdominal
pain, the use is more practical, inexpensive
and comfortable, but they complain about
menstrual irregularities, some have
amenorrhoea, some do not. having
menstruation at all.
Many factors influence a person in
choosing a pill and injection contraceptive
method such as knowledge, education level,
economic status, parity, health services,
occupation, age, husband's support, beliefs or
religion and culture. These factors will also
influence the success of the family planning
program (Jitowiyo & Rouf, 2019). This is in
line with research conducted by Melisa R.
(2019) saying that there is a significant
relationship between age and specialization in
Pill and Injection contraceptives, knowledge
factors with specialization in Pill and Injection
contraceptives, and the number of children
interested in Pill and Injection contraceptives.
(Sherly, 2015).
Although many acceptors choose to use
contraceptive pills and injections, there are
still many mothers who do not know the side
effects of contraception. Contraceptive pills
have side effects such as dizziness, nausea,
vomiting, irregular bleeding and amenorrhoea.
Meanwhile, injectable contraceptives have
side effects including headaches, weight gain
and the most frequently complained of is the
disturbance of menstrual patterns in the form
of ammonera, longer bleeding and some even
do not experience menstruation at all. Even
though they have side effects, the use of
contraceptives is actually beneficial for
women or mothers in improving the welfare of
the family. These advantages include
maintaining pregnancy distance,
accompanying children's growth and
development, having time to socialize with the
environment and having space for married
couples to create a harmonious family and
help the family economy.
Efforts made to increase the percentage
of contraceptive use are by means of effective
communication, providing information and
education (IEC) about the benefits of
contraception and counseling, this is really
necessary in family planning services. By
conducting counseling, it means that the
officer helps the clan in choosing and deciding
the type of contraception to use according to
his choice.
Based on the description above, the
authors are interested in examining the factors
that influence the high selection of
contraceptives for oral contraceptives and
injection contraceptives.
RESEARCH METHODS
This research is a literature study or
literature review, which is a critical evaluation
of several studies and theories related to
certain topics. This process involves analysis
and synthesis of previous work to produce a
summary of knowledge on the topic (Michael
Coughlan, Patricia Cronin, & Frances Ryan,
2013). The problem in this study is to
determine "the factors that influence the choice
of contraceptive pills and injections".
In this study, literature searches were
carried out from March-May 2020 using
keywords and boolean operators (AND, OR
NOT or AND NOT) which function to expand
or specify searches, and the keywords used in
this study are factors that influence tools
selection. contraceptive pills and injections.
The sources used are 10 journals consisting of
8 national journals and 2 international journals.
These journals are accessed from google
scholar, pubmed, Ersjournal, and MDPI.
RESULTS AND DISCUSSION
The results obtained in the literature
review study found 10 journals consisting of 8
national and 2 international journals which
have been selected and have similarities in this
study and will be discussed as follows: Factors
that influence the choice of contraceptive pills
and injections.
1. Education
 Results of research conducted (Bakri,
Kundre, & Bidjuni, 2019) The 44 respondents
found that most of the respondents had high
school education, 20 acceptors (45.5%). The
results of this study are in line with the results
of research conducted by (Signal, Rompas, &
Bataha, 2019), which show that the largest
number of respondents who use contraception
are at the high school education level.
Education is basically an attempt to
develop knowledge, attitudes and skills.
According to (Notoatmodjo, 2012), generally
the higher a person's education level, the easier
it is for someone to receive information from
the social environment or through social media.
This is because education is one of factors
that greatly determines one's knowledge and
perception of the importance of something,
including the importance of participating in
using contraceptives. These results indicate a
good level of education will help acceptors in
understanding the information related to
contraceptive use.
Researchers assume that in terms of
education, the higher one's education is, the
easier it is to receive information so that the
more knowledge one has. So that in the
concept of education there is a process of
growth, development or change to a more
mature direction, with the development of a
better mindset. At the secondary education
level, a person has good insight and level of
knowledge so that he is open to new things,
including being open to contraceptive methods.
This shows that the level of education is
related to public health behavior, so it can be
concluded that with higher education one is
expected to be easier to receive messages and
motivation in choosing the contraceptive
method. The higher the level of education of a
person, it is expected that their knowledge will
be higher, especially regarding the choice of
family planning they use, so that people can
also reconsider choosing a contraceptive
method, both in terms of the advantages or
side effects of the method.
2. Economic Status
Research conducted by (Hasnani, 2019).
In 62 respondents who were studied at Langsa
Lama Public Health Center, the respondents
had a high socio-economy, namely 34
respondents (54.8%) and respondents who had
a low socio-economy were 28 respondents
(45.2%). The results of the test for different
proportions (X2) showed a relationship
between contraceptive choices on the socio-
economic conditions at Langsa Lama Public
Health Center Langsa City (Pvalue = 0.000 <).
The results showed that acceptors with high
socioeconomic levels chose injection as a
contraceptive tool. This is in line with research
(Lontaan, Kusmiyati, & Dompas, 2014),
regarding the factors associated with
contraceptive selection. The results of study
show that there is a relationship between
socio-economics and the choice of
contraception.
The level of social status and economic
conditions can affect the development and
progress of the family planning program.
Economy is a description of the level of a
person's life in society which is determined by
income and expenditure variables. Economic
conditions can affect aspects of a person's life
including health care according to
Notoatmodjo (2012) quoted in (Jitowiyo &
Rouf, 2019).
Researchers assume that a person's
income is related to a person's ability to meet
the needs of life, the higher the socio-economy
the more needs, facilities that can be fulfilled.
The income a person has will support him / her
in meeting his needs for contraception which
also affects the choice of contraceptive method
he will use. Someone who has an income will
be able to choose the right contraceptive
method.
3. Parity
The results of the research conducted by
(Baharu, 2019) found that most respondents
had 2-3 children 38 acceptors (60.3%), based
on the results of the analysis, there was a
significant relationship between the number of
children and the specialization of Pill and
Injection contraception.
The number of children owned affects
the choice of contraceptive method to be used.
Mothers who already have 2 children are
advised to use hormonal contraceptives which
have high effectiveness, so that the possibility
of experiencing another pregnancy is quite low.
Based on the data above, most respondents
chose Hormonal family planning because their
number of children was multiparous or had
more than 2 children and the respondents were
in the fertile age phase so they wanted to space
their pregnancies in accordance with the
wishes of the pairs of childbearing age. Thus,
each child owned by a married couple will
give consideration to whether they want to
have children and if so, how many they want.
The number of children is closely related to
the level of family welfare. The more children
you have, the greater the tendency to stop
fertility so that you are more likely to choose a
steady contraceptive device (Rosita, 2012).
Researchers assume that in general
family planning acceptors prefer the pill and
injection contraceptive method for more
practical reasons. However, no single
contraceptive method is safe and effective for
all acceptors, because each has an individual
suitability and suitability for each acceptor. In
general, the requirements for the ideal
contraceptive method are as follows: Safe,
meaning that it does not cause serious
complications when used, including does not
cause disturbing effects during intercourse.
Efficient, in the sense that it is used in
accordance with the rules, it will prevent
pregnancy. Can be accepted, not only by
family planning acceptors but also by the
community's cultural environment. Affordable,
if the method is discontinued, the
acceptorswill return to its fertility. Easy to
implement, acceptable to use by partners.
4. Profession
Research conducted by (Signal, Rompas,
& Bataha, 2019), entitled the use of
contraceptives by accessors in Manado
medical center hospitals. Based on the
respondent's occupation, most of them work as
entrepreneurs, amounting to 20 people
(34.5%). 14 people (24.1%) work as civil
servants (24.1%), 14 people (24.1%) work as
employees, and 10 people (17.2%) as IRT.
Women who work have expensive time so that
there are fewer opportunities to take care of
children than women who do not work, so that
women who work will tend to limit the
number of children.
The results of the study
(Lieskusumastuti & Setyorini, 2019), show
that women who use contraceptives are more
likely to work. These results show that
working women can also gain experience and
knowledge compared to women who do not
work to have less information than women
who work. In accordance with the theory of
Kutanegara, et al, (2010) quoted in (Jitowiyo
& Rouf, 2019) it is said that in general the
number of contraceptive use for working
women is higher than for women who do not
work. Women who work mostly spend time at
work such as self-employed, civil servants /
private sector, and employees. Those who
work for approximately 10 hours, resulting in
them having less time to take care of their
children. Therefore they use contraceptives to
control pregnancy.
Researchers assume that a person's job
affects the chosen contraceptive method. The
value of time held by working women is more
expensive than that of women who do not
work. There are fewer opportunities for
women to work to care for children than for
women who do not work. Therefore, working
women will tend to use contraceptives to limit
the number of children. Another thing that
influences working women to choose this
contraceptive method because this
contraceptive method is practical and effective
and does not burden them in their work.
5. Age
Research conducted by
(Lieskusumastuti & Setyorini, 2019) shows
that 24 respondents (72.7%) are 20-35 years
old, and 1 respondent (3%) is <20 years old.
The results of this study indicate that the
majority of respondents who use contraception
are at the age of 20-35 years. This research is
in line with the research conducted by (Durul,
Emelumadu, & Iwul, 2018).
According to (Yanuar, 2010) quoted in
(Jitowiyo & Rouf, 2019) a person's age
determines which contraceptive method to
choose. The older a person is, the higher the
chances of not wanting to get pregnant again
and to choose a suitable and effective
contraceptive method. Women's age has an
influence on the choice of family planning
programs. Age <20 years is the age to delay
pregnancy, ages 20 - 35 are the age to regulate
pregnancy, and age> 35 is the age to limit
pregnancy. The more old enough, the maturity
level and strength of a person will be more
mature in thinking and working. Fertile age is
where a woman begins to have her first
menstrual period, meaning that ovulation has
occurred until menopause (unable to produce
eggs). Generally, the fertile age in Indonesia
ranges from 15-19 years. The average acceptor
aged 20-35 years using hormonal birth control,
this is because the age of 20-35 years is the
right age to become hormonal family planning
acceptors. The acceptors who are old enough
will be more mature in choosing and
establishing themselves as family planning
acceptors.
Researchers assume that the younger the
acceptors will choose the short-term
contraceptive method, because the acceptors
still want to have more children. Meanwhile,
the older they are, the acceptors will choose a
long-term contraceptive method because
acceptors will limit having children.
6. Husband's Support
The results of the study (Lusiana, 2017),
65 respondents (100%) found that 62
respondents (95.4%) husbands support family
planning acceptors, and 3 respondents (4.6%)
do not support family planning acceptors. This
shows that in the choice of contraceptive use
by family planning acceptors, support from
partners is very influential. This is in line with
the research conducted by (Bakri, Kundre, &
Bidjuni, 2019) which states that there is a
relationship between husband's support and the
choice of contraceptive method.
A wife in making the decision to use
contraception needs the consent of the husband
because the husband is seen as the head of the
family, the protector of the family, the
breadwinner and someone who can make
decisions in a family. In making the decision
to use contraceptives, the husband's support
includes efforts to obtain information,
choosing a contraceptive device, delivering
him to health services and financing the
installation of contraceptives. The better the
support provided by the husband, in making
decisions according to the wishes of the
husband and wife, on the other hand, if the
husband's support is lacking, the husband's
dissatisfaction will arise in using
contraceptives. Therefore, support from
partners is influential in determining
contraceptive use decisions and also considers
the advantages and disadvantages of a
particular method (Jitowiyo & Rouf, 2019).
Researchers assume that mothers who
do not receive support from their husbands in
choosing a contraceptive method are because
their husbands cannot accept changes in the
side effects of the current contraceptive
method used by mothers, mothers and
husbands do not know the types of
contraception.
7. Trust and Culture
The results of research conducted by
(Basra & Fatimah, 2017) show that of the 30
respondents who believe in contraception as
many as 3 people (10%) and do not believe as
many as 27 people (90%).
According to (Jitowiyo & Rouf, 2019)
the views of various religions on family
planning, namely the first is the Islamic
religion which prohibits the type of
contraceptive vasectomy and tubectomy
because it has permanent properties but there
are also Muslims that allow contraception.
Secondly, Catholicism is allowed only natural
family planning or periodic abstinence so that
other types of contraception are not allowed.
As a social human being is inseparable from
the culture in which he lives. Culture concerns
traditions, customs, rules and opinions. The
use of contraceptives is closely related to
culture, because contraceptives are related to
the way they are installed and the habits of
using them. As it is known, the insertion of the
IUD contraceptive for example, the insertion
of this device through the female genitals is
not accepted by people in certain cultural
environments. In addition, its use is related to
the habits of people living in certain
environments. A person will be interested in
using the wrong form of contraception if the
people around him are using the same
contraception. for example, someone's interest
in the use of injectable contraceptives will
arise if people around them also use injectable
contraceptives. This includes habits passed
down from generation to generation, from
mother to child, and so on (Setiyaningrum,
2016).
Researchers assume that it is necessary
to involve religious and community leaders in
conducting counseling about the use of
contraceptive methods in the community. For
example, by inviting clerics or village heads
whose wives have used contraceptives so that
they can become references and role models
for the community in using contraceptives.
CONCLUSIONS AND SUGGESTIONS
CONCLUSIONS
1. Acceptors using Pill and
Injection contraceptives
according to education level are
high school seniors.
2. Acceptors with high
socioeconomic levels used more
pill and injection contraceptives.
3. Acceptors who use Pill and
Injection contraceptives have 2
to 3 children.
4. Acceptors who use the
contraceptive pill and injection
contraceptive are those who
work.
5. The majority of respondents
who used contraception were at
the age of 20-35 years.
6. More husbands used the pill and
injection contraceptives to
support family planning
acceptors.
7. Acceptors who used Pill and
Injection contraceptives
according to their beliefs and
cultures were acceptors who did
not believe in beliefs and
culture.
Of the seven factors, the factors
most influencing the choice of
contraceptive pills and
injections were husband support,
beliefs and culture, age, parity,
economic status, education, and
educational factors.
SUGGESTIONS
1. For family planning acceptors
It is hoped that following the latest
health service developments, as well
as being more active in seeking
information about the development of
family planning acceptors in the
selection of hormonal contraceptives.
2. For institutions
Hopefully the results of this literature
study can be used as a reference and
become a collection of books in the
library to prepare future researchers
and as a reference in providing
guidance to students.
3. For further researchers
For future researchers, because this
thesis is only a literature study,
hopefully it can be used as a guide and
can explore more about the factors that
influence the choice of contraceptive
pills and injections.
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