JOURNAL

THE CHOICE OF IMPLANTABLE CONTRACEPTION IS SEEN FROM ACCESS TO

SERVICE FACILITIES AND THE ROLE OF THE HUSBAND IN
AT BLUD UPTD PUSKESMAS MOTAHA

By :
Sitti Sahrah
NIM. 2281A0457

BACHELOR OF MIDWIFERY STUDY PROGRAM

FACULTY OF NURSING AND MIDWIFERY
STRADA INDONESIA INSTITUTE OF HEALTH SCIENCES (IIK).
YEAR 2023

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 ABSTRACT

THE SELECTION OF IMPLANTABLE CONTRACEPTIVES IS REVIEWED

FROM ACCESS TO SERVICE FACILITIES AND THE ROLE OF HUSBANDS IN PUS
AT BLUD UPTD PUSKESMAS MOTAHA IN 2023

Sitti Sahrah, Vidia Atika Manggiasih

STRADA Institute of Health Sciences Indonesia
ssahrah791@gmail.com

Implant contraception is one of the MKJP (long-term contraceptive methods), namely a

method that has high effectiveness with a low failure rate and low complications and has few
side effects compared to other contraceptive methods. Once used, it lasts for 3 years. This
study aims to determine the relationship between the choice of contraceptive implant in terms
of access to service facilities and the role of the husband in PUS at BLUD UPTD Motaha
Community Health Center.

This research uses a Quantitative Observational Analytical research design with a cross
sectional approach. Using the accidental sampling technique, a sample of 30 respondents was
obtained, the independent variable was access to service facilities and the role of the husband
using a questionnaire and the dependent variable was selecting implant contraception using a
questionnaire. The Chi-Square statistical test was used to determine the relationship between
the two variables.

The results of the research from 30 respondents showed that the majority of respondents
had criteria for access to service facilities <4 km, as many as 19 respondents (63.3%), the
majority of respondents had a very good role, namely as many as 15 respondents (50%). And it
was found that the majority of respondents with criteria for using implant contraception were
16 respondents (53.3%).

Analysis using the Chi-Square statistical test resulted in p = 0.003 < 0.05, so H0 was
rejected and H1 was accepted, which means there is a relationship between access to service
facilities and the choice of implant contraception at the Motaha Community Health Center
UPTD BLUD. And the Chi-Square statistical test resulted in p = 0.031 < 0.05, so H0 was
rejected and H1 was accepted, which means there is a relationship between the role of the
husband and the choice of implant contraception at the BLUD UPTD Motaha Community
Health Center.

Choosing the right contraception is one way to succeed the family planning program and
reduce MMR and AKB in mothers who have a history of problematic childbirth and mothers at
high risk. One of them is by using contraceptive implants that have long-term protection.

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 Keywords: Access, Facilities, Husband's Role, contraception, implants.

INTRODUCTION

Indonesia is the country with the fourth largest population in the world. The population
of Indonesia in 2020 is 273,879,750 people (Dukcapil 2022). The government has made efforts
to use family planning to control the population which can reduce the Maternal Mortality Rate
(MMR). The MMR indicator shows a decreasing trend (per 100,000 live births) from 390 in
1991 to 230 in 2020 or a decrease of 1.80% per year. However, the MMR in Indonesia is
currently still far from the Sustainable Development Goals (SDGs) target of 70 per 100,000
live births in 2030. The government is pursuing a strategic program to reduce the still high
MMR in the Regulation of the Head of the National Population and Family Planning Agency
Number 18 of 2020 concerning Postpartum Family Planning Services (KBPP).

The family planning program is not "merely" aimed at controlling the population (birth
control), but is aimed at achieving quality families. Creating a quality family in a healthy
environment needs to be prioritized because the family is the smallest socio-economic unit in
society which is the basic foundation of a society. The family also has a number of strategic
functions that cannot be replaced by any institution. The formation of a quality family will give
birth to a quality society and nation. Through the family planning program, women can manage
their pregnancies and the death rate of pregnant women can be reduced.

The family planning program is one part of reproductive and sexual health services. The
approach to contraceptive services in Indonesia adheres to human rights principles. These
principles are translated into providing responsible freedom for couples to determine the
number, spacing and limitation of 2 pregnancies as well as information and ways to fulfill their
reproductive rights. The availability of various choices of contraceptive devices and drugs at
service points with complete information is mandatory and is a current challenge for the
Government. (Ministry of Health, 2014) Planning a family by using contraception is a rational
effort in the current millennial era. Therefore, it is very important to plan your family by using
both hormonal and non-hormonal contraceptives.

The government has provided a variety of contraceptive methods, but short-term birth
control such as injectable birth control is still the most popular choice for family planning use.
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The government has prioritized the use of MKJP with a small risk of pregnancy, but its use has
not been optimal.
Long-term contraceptive methods (MKJP) are contraceptive methods that have a high
level of effectiveness with low failure rates and low complications and have fewer side effects
compared to other contraceptive methods. MKJP is a type of contraception that once used can
last for 3 years or a lifetime. (unair, 2019). MKJP includes, IUD, Implant, MOP, and MOW.
Meanwhile, non-MKJP includes injections, condoms and pills (BKKBN, 2019).
Implants are a hormonal contraceptive method that is effective, not permanent and can
prevent pregnancy for between three and five years. This method was developed by the
Population Council, an international organization founded in 1952 to develop contraceptive
methods. The implant is a contraceptive device that is placed under the skin of the upper arm in
the form of a flexible silastic capsule where each capsule contains the hormone levernorgestril
which can prevent pregnancy. This contraceptive implant works by inhibiting ovulation, causing
the endometrial mucous membrane to not be ready to accept fertilization (nidation), thickening
the mucus and thinning the endometrial lining with the effectiveness of implant contraceptive
success being 97-99% (BKKBN, 2014).
According to the 2019 health profile, the number of active family planning and new
family planning, the number of PUS (fertile age couples) throughout Indonesia was 48,536,690
people with the number of active family planning participants being 36,306,662 (74.80%) people
and the number of new family planning being 6,663,156 people (13.73%). The percentage of new
family planning participants according to contraceptive methods in Indonesia, namely IUD
481,564 (7.23%), MOW 115,531 (1.73%), MOP 11,765 (0.18%), implant 757,926 (11.37%),
condoms 318,625 ( 4.78%), injections 3,433,666 (51.53%), pills 1,544,079 (23.17%), and the
percentage of active family planning participants, namely condoms 1,171,509 (3.23%), pills
8,280,823 (22.81%), Injections 17,414,144 (47.96%), IUDs 3,852,561 (10.61%), implants
4,067,699 (11.20%), MOW 1,285,991(3.54%) , MOP 233,935 (0.64%). (RI Ministry of Health,
2019).
Southeast Sulawesi Provincial Health Service Profile Data in 2021 reported a population
of 2,659,156 people, a total of 476,196 PUS active family planning participants 249,931
(52.48%) injectable family planning participants 132,251 (52.92%), pills 79,063 (31.63% ),

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Implants 26,815 (10.73%), IUDs 4,674 (1.87%), Condoms 3,480 (1.39%), MOW 3,234 (1.29%),
MOP 414 (0.17%).

RESEARCH METHODS

This research was carried out as a quantitative observational study with an analytical cross-
sectional design. Using the accidental sampling technique, a sample of 30 respondents was
obtained, the independent variable was access to service facilities and the role of the husband and
the dependent variable was the selection of contraceptive implants through interviews. The Chi-
Square statistical test was used to determine the relationship between the two variables. Analysis
using the Chi-Square statistical test resulted in p = 0.003 <0.05, so H0 was rejected and H1 was
accepted, which means there is a relationship between access to service facilities and the choice
of implant contraception and . Analysis using the Chi-Square statistical test resulted in p = 0.031
<0.05, so H0 was rejected and H1 was accepted, which means there is a relationship between the
husband's role and the choice of implant contraception.

RESEARCH RESULT
Table.1 Distribution of Respondent Characteristics and Variables
Research result Frekuensi (f) Persen (%)
Age
20-29 years old 8 26,7
30-39 years old 14 46,7
>40 years 8 26,6
Education
elementary school 1 3,3
JUNIOR HIGH SCHOOL 7 23,4
SENIOR HIGH SCHOOL 22 73,3
D3/S1 0 0,0
Access to Service Facilities
<4 Km 19 63,3
>4 Km 11 36,7
Role of Husband
Very good 15 50
Good 10 33,3
Not good 5 16,7
Very Not Good 0 0,0
Selection of Implant Contraception
Implant 16 53,3
Not an Implant 14 46,7
Amount 30 100
Source: Research Questionnaire,

Table 2 Cross Tabulation Between Variables

Selection of Implant Total
Contraception
implant Not Bukan implan
an implant

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 Access to <4 Km Frekuensi 2 9 11
service % 18,2% 81,8% 36,7%
facilities >4 Km Frekuensi 14 5 19
% 73.3% 26,2% 63.3%
Total Frekuensi 16 14 30
% 53,3% 46,7% 100.0%
The role of The role of Frekuensi 10 5 15
the the % 66.7% 33,3% 50%
husband husband is
very good

Good Frekuensi 6 4 10
% 60% 40% 33,3%
Not good Frekuensi 0 5 22
% 0% 100% 16,7%
Very Not Frekuensi 0 0 0
Good % 0% 0% 0%
Total Frekuensi 16 14 30
% 53,3% 46,7% 100.0%
Source: Research Questionnaire,

Based on Table. above, it is known that respondents who did not choose implants were
found to be >4 km away, namely 9 respondents (81.8%), while respondents whose husband's role
was very good chose implants, namely 10 respondents (66.7%).

Analysis of Research Statistical Test Results

Value Approx. Sig.

Nominal by Nominal Contingency Coefficient 8.623 .003
N of Valid Cases 30

The results of the research analysis regarding the relationship between access to service
facilities and the choice of contraceptive implants based on statistical tests using the Chi-Square
test showed that p = 0.003 < 0.05, so Ho was rejected and Ha was accepted, which means there is
a relationship between access to service facilities and the choice of contraceptive implants in
BLUD. Motaha Community Health Center UPTD

Value Approx. Sig.

Nominal by Nominal Contingency Coefficient 6.964 .031
N of Valid Cases 30

The results of the research analysis regarding the relationship between the husband's role and the
choice of implant contraception based on statistical tests using the Chi-Square test showed that p
= 0.031 < 0.05, so H0 was rejected and Ha was accepted, which means there is a relationship
between the husband's role and the choice of implant contraception at the BLUD UPTD Motaha
Community Health Center.

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 DISCUSSION

A. Identifying the Relationship between the Choice of Implant Contraception in

View of Access to Service Facilities at BLUD UPTD Motaha Community Health Center in

2023

Based on table 4.3, it can be seen that of the 11 respondents who had access to service

facilities over a distance of >4 km, there were 2 respondents (18.2%) who chose implant

contraception and 9 respondents (81.8%) who did not choose implant contraception, while from

19 respondents had access to service facilities close to <4 km, there were 5 respondents

(26.2%) who did not choose implant contraception and 14 respondents (73.3%) chose implants.

Statistically using Chi Square (X}) analysis at a significance level of 95% shows that

there is a significant relationship between access to service facilities and the choice of

contraceptive implants in the BLUD UPTD Motaha Community Health Center in 2023 which

is indicated by a value of p = 0.003 <a = 0.05 .

The results of this study are the same as research conducted by Nyimas et al which stated

that there was a relationship between access to service facilities and the choice of type of

contraceptive implant, that there was a significant relationship between access to service

facilities and the choice of contraceptive implant.

Based on the theory put forward by Saifuddin (2003), in general patients will look for

health care at a health facility located near where they live. If for some reason they visit a

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service center that is far away, the clinic staff must be able to help and explain the facilities.

nearest health center that can provide advanced health care and services.

Researchers concluded that the characteristics of access to service facilities are one of the

considerations for prospective acceptors in determining the use of implants. Apart from that,

access to services. Effective services can only be guaranteed if services are financially

affordable, deemed appropriate and acceptable to women as service users. Access to services

that is too far > 4 km will make it difficult for women to get services. It is best that the distance

is at least ≤ 4 km from the family planning acceptor's house to make it easier to get services.

Bivariately, the research results show that there is a significant relationship between

access to service facilities and the choice of implantable contraceptives at the BLUD UPTD

Motaha Community Health Center in 2023.

According to the researchers' assumptions, the results of this study indicate that access to

service facilities is significantly related to the choice of implantable contraceptives at the

Motaha Community Health Center UPTD BLUD. This is because there are more respondents

who choose contraceptive implants with access to service facilities <4 km closer than

respondents who have access to service facilities >4 km away.

Apart from that, the majority of respondents chose implant contraception with access to

service facilities < 4 km close because it was easy to reach the service location. Meanwhile,

some respondents who did not choose implant contraception had access to service facilities > 4

km away because of the long distance, bad road access and lack of finances.

B. Identifying the relationship between the choice of implant contraception in terms

of the role of the husband in the BLUD UPTD Motaha Community Health Center

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 Based on table 4.4, it can be seen that of the 16 respondents whose husband's role was in

the very good category, there were 10 respondents (66.7%), good, there were 6 respondents

(60.0%), and not good, there were 0 respondents who chose the contraceptive implant.

Meanwhile, of the 14 respondents whose husband's role was in the very good category, 5

respondents (33.3%), there were 4 respondents good (40%), and there were 5 respondents who

did not choose implantable contraception.

Statistically using Chi Square (X}) analysis at a significance level of 95%, it shows that

there is a significant relationship between the role of the husband and the choice of implant

contraceptives in the BLUD UPTD Motaha Community Health Center in 2023 which is

indicated by a p value of - 0.031 < a = 0.05.

This indicates that the husband is the first and main person in providing encouragement

and support to the wife before other parties pay attention. The better the support the husband

gives the mother, the more potential the mother has to choose contraceptives. Husband and

family support can provide benefits

emotional, namely giving individuals a sense of comfort and providing enthusiasm in

carrying out individual actions that strengthen their sense of belonging or being loved and

influence behavior, including early detection of cervical cancer (Henzayana, 2017).

From the results of this study, it was found that mothers who received support from their

husbands were more likely than mothers who did not receive support from their husbands. A

husband who knows information about the importance of contraceptive implants will certainly

advise his wife to install contraceptive implants, as well as know the schedule, accompany and

provide transportation for mothers to get to health facilities. According to Arum & Sujiyatini

(2009), the advantages of implant contraception include high efficacy, long-term protection (up
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to 3 years), rapid return of fertility levels after removal, does not require internal examination,

is free from the influence of estrogen, does not interfere with sexual activity, does not interfere

with sexual activity. Breast milk, Clients only need to return to the clinic if there are

complaints. Can be withdrawn at any time according to the complaint. The husband's role is the

effort given by the husband both mentally, physically and emotionally. Husband's support is a

social resource that can be used to deal with pressure on individuals in need, husband's support

can be expressed through appreciation and interest in his wife, tolerance, showing affection and

helping in dealing with a problem experienced by the wife (Rafidah & Aryekti, 2016) .

Bivariately, the research results show that there is a positive and significant relationship
between husband's support and the choice of contraceptive implants at the Motaha Community
Health Center UPTD BLUD. The results of this study are in line with the results of research by
Nyimas et al and Cristian, where data was obtained that there was a significant relationship
between the role of the husband and the choice of contraceptive implant.
The results of this panel showed that of the 25 husbands who responded very well and
well, there were 16 respondents who chose implant contraception because of the parity of
respondents in the risk category, not yet ready to get pregnant again, a history of high-risk
childbirth.
Of the 25 husbands who responded very well and well, there were 9 respondents and 5
respondents who did not choose implant contraception were not good. This is because there are
respondents who have low education, which affects knowledge about implants, both the
advantages and disadvantages of implants.

C. Identifying the choice of implant contraception in the Motaha Community Health

Center UPTD BLUD

Based on table 4.1, it is known that the majority of respondents used implant contraception,
namely 16 respondents (53.3%) and 14 respondents (46.7%) did not use implants.
The government has made efforts to use family planning to control the population which can
reduce the Maternal Mortality Rate (MMR). The family planning program is not "merely" aimed
10
at controlling the population (birth control), but is aimed at achieving quality families. Creating a
quality family in a healthy environment needs to be prioritized because the family is the smallest
socio-economic unit in society which is the basic foundation of a society. The government has
provided a variety of contraceptive methods, but short-term birth control such as injectable birth
control is still the most popular choice for family planning use. The government has prioritized
the use of MKJP with a small risk of pregnancy, but its use has not been optimal.
According to researchers, the majority of respondents used implants in this study. In the
researchers' opinion, this can reduce the risk of IMR and AKI for mothers who are at high risk
during childbirth. Using implants can prevent long-term pregnancy, namely for approximately 3
years with little risk.
Meanwhile, mothers who do not use implants have a high risk of pregnancy, such as many
mothers who use PIL contraceptives who do not take PIL every day, resulting in unexpected
pregnancies.

D. Identifying the distribution of access to service facilities and the role of husbands in PUS
with the selection of implant contraception in the BLUD UPTD Motaha Community Health
Center

The results of the research analysis regarding the relationship between access to service facilities
and the choice of contraceptive implants based on statistical tests using the Chi-Square test
showed that p = 0.003 < 0.05, so Ho was rejected and Ha was accepted, which means there is a
relationship between access to service facilities and the choice of contraceptive implants in
BLUD. Motaha Community Health Center UPTD. With a correlation coefficient value of 0.472,
which means the level of relationship is in the strong relationship category, where the correlation
value range is between 0.60-0.799, which is included in the strong relationship category
(Sugiyono, 2010).
The results of the research analysis regarding the relationship between the husband's role and the
choice of implant contraception based on statistical tests using the Chi-Square test showed that p
= 0.031 < 0.05, so H0 was rejected and Ha was accepted, which means there is a relationship
between the husband's role and the choice of implant contraception at the BLUD UPTD Motaha
Community Health Center. With a correlation coefficient value of 0.434, which means the level

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of relationship is in the strong relationship category, where the correlation value range is between
0.60-0.799, which is included in the strong relationship category (Sugiyono, 2010).
Access to Health Facilities provides information regarding population access to various types of
health facilities. Health facility indicators are used to show how easily the population, especially
the poor and vulnerable, can access health facilities that are important for their lives. Like other
access indicators, ease of access to health facilities is measured using the distance from the
village/kelurahan to the location where the facility is located.
In the researcher's opinion, there is a relationship between access to service facilities and the
husband's role with the choice of implant contraception at the BLUD UPTD Motaha Community
Health Center. In this study, this research proves that access to service facilities and the husband's
role have an impact on mothers choosing implant contraception. This is proven by the results of
this study, namely that there is a strong relationship between access to service facilities and the
role of the husband with the choice of implant contraception. This is due to support for access to
service facilities, the role of the husband and the mother's strong desire to have implant
contraception as well as awareness of her own condition and the long-term benefits of implant
contraception.

CONCLUSION

1. Based on table 4.1, it is known that access to service facilities was obtained by most
respondents with the criteria of being close to <4 Km, namely 19 respondents (63.3%).
2. Based on table 4.2, it is known that the majority of respondents found the Role of the Husband
in the very good category, namely 15 respondents (50%).
3. Based on table 4.3, it is known that in choosing implant contraception, the majority of
respondents used implants, namely 16 respondents (53.3%).
4. There is a significant relationship between access to service facilities and the choice of
contraceptive implants at the PUS at BLUD UPTD Motaha Community Health Center in
2023.
5. There is a significant relationship between the role of the husband and the choice of
contraceptive implant in PUS at the BLUD UPTD Motaha Community Health Center in 2023.

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6. There is a significant relationship between access to service facilities and the role of the
husband with the choice of contraceptive implant at the BLUD UPTD Motaha Community
Health Center in 2023.

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