KnE Life Sciences | The 2nd International Meeting of Public Health 2016 | pages: 410–414

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1. Introduction

Maternal mortality is projected to increase 1.8 times higher for women who are not using contraception (Ahmed et al. n.d.). Among many interventions, using contraception as the prevention of unwanted pregnancy is one of the most cost-effective ways to reduce maternal mortality (Bongaarts & Sinding 2009).

Some of the literatures on reproduction health describe the association between contraception use and women empowerment (Govindasamy dan Malhotra, n.d.; Blanc 2001; Al Riyami et al. 2004; Hameed et al. 2014; Do & Kurimoto 201M). West Nusa Tenggara is a region that receives a hundred percent contraception procurement programme under procurement equipment and free medicine policy on the KB (family planning) care which is addressed to all reproductive-age couples and based on Head of BKKBN provision (Perka) number 78 / PER / E3 / 2011 (BKKBN 2011). One of that operational policies is intended to increase prevalence of KB use. However, according to Indonesia Demographic Health Survey (SDKI) in 2012, Contraception Prevalence Rate of West Nusa Tenggara was still below of national achievement which was only 56 percent (BKKBN et al. 2013).

2. Methods

This was secondary data analysis, conducted to examine the association between women empowerment on taking decision and contraception use among reproductive-age women in West Nusa Tenggara Province particularly West Lombok, East Lombok, and Sumbawa District. The data were obtained from Improving Contraceptive Method Mix (ICMM) project conducted by the Center for Health Research, the University of Indonesia in 2013. The study sample was reproductive, married but not pregnant women, aged 15-49 years old. Variables examined in the study were the contraception use and women's participation in decision making in term of economic, household, and physical mobility.

Empowerment regarding economic decision-making was respondent's participation to decide daily necessities spending (toothpaste, soap, etc.) and expensive household expenditure (TV, Refrigerator, etc). Decision making empowerment in the household decision making participation was respondent's participation to decide children and wife health care whereas empowerment in term of physical mobility was respondent's participation to decide if they would work.

3. Results

The distribution of the contraception use in West Nusa Tenggara Province included the use by productive age women aged between 15-49 years old and the method of the contraception use.. The contraception use could be found in 1,522 people (72.9%) in West Lombok, 1,234 people (54.8%) in East Lombok, and 1,494 (65.5%) in Sumbawa, amounting to 4,250 people (64.3%) in West Nusa Tenggara Province.

Table 1

Distribution of Woman Empowerment in West Nusa Tenggara in 2013 (n=6613).


Women Empowerment West Lombok (n=2079) East Lombok (n=2252) Sumbawa (n=2282) Total (n=6613)
Economic Decision
Empowered 24.4% 27.8% 32.4% 84.4%
Unempowered 7.2% 6.3% 2.1% 15.6%
Household Decision
Empowered 28.1% 29.8% 31.1% 89.0%
Unempowered 3.3% 4.2% 3.4% 11.0%
Physical Mobility
Empowered 17.9% 19.5% 17.9% 55.3%
Unempowered 7.2% 14.6% 16.6% 44.7%
Table 2

Distribution of Contraception Use According to the Women's Empowerment in West Nusa Tenggara Province (n=6613).


Women's Empowerment Contraception Use Total OR p-value
Yes No
n % N % n %
Economic Decision
   Empowered 3563 63.8 2018 36.2 5581 100 1.128 0.097
   Unempowered 687 66.6 345 33.4 1032 100
Household Decision
   Empowered 3821 64.9 2065 35.1 5886 100 0.778 0.002
   Unempowered 429 59.0 298 41.0 727 100
Physical Mobility Decision
   Empowered 2321 63.5 1333 36.5 3654 100 1.076 0.164
   Unempowered 1929 65.2 1030 34.8 2959 100

In economic decision making, the proportion of respondents using contraception was greater in unempowered respondents compared to empowered which was 66.6% for the unempowered respondents and 63.8% for the empowered respondents. Empowerment economic decision making was not associated with contraception use (p-value = 0.097). As for households decision making, it showed that the proportion of respondents who used contraception was greater to the empowered respondents (64.9%) than unempowered respondents (59%) (p-value = 0.002; OR = 0.778). Reproductive age women who were unempowered in households decision making were 0.778 times less likely to use contraception. In physical mobility empowered dimension, the proportion of respondents who used contraception was almost balanced between unempowered respondents (65.2%) and empowered (63.5%) and their relationship was not statistically significant (p-value = 0.164).

4. Discussion

Patrikar et al. (2013) states that contraception use is influenced by many things including by women empowered in decision making (Patrikar et al. 2014). In Safe Motherhood, the women empowerment is the most basic foundation on reducing maternal mortality. The women empowerment underlies primary health care in the form of family planning, antenatal care, clean and safe delivery, and essential obstetric care (World Health Organization 1996). This means that women who are empowered to make decisions in the household will have good access to primary health care, in which one of the access is the right to obtain contraception services that are suitable with their own preferences.

Women empowerment itself is influenced by their social and economic status, including women's knowledge (Asian Development Bank 2016). Therefore improving women health, including contraception use also depends on improving the standard of living, education, and their working conditions. Women must be seen as an agent of change, not merely as a recipient of the intervention.

5. Conclusions

Women empowerment on household decision making was associated with contraception use in West Nusa Tenggara. Therefore, women empowerment might be one strategy to increase the contraception use by improving the standard of living, education, and their working conditions.

Acknowledgment

We thank the Ministry of Health and National Family Planning Coordinating Board, Health office and BKKBN in West Nusa Tenggara, Health office and Community Empowerment Board at Village Government and Family Planning in West Lombok District, East Lombok, and Sumbawa. We also would like to thank Johns Hopkins Center for Communication Programme (JH-CCP) and the Center for Health Research, University of Indonesia PPK (UI) that have given permission to use the data of Improving Contraceptive Method Mix (ICMM), which is funded by United States Agency for International Development (USAID) and the Department of Foreign and Trade (DFAT) as this research material.

References

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Ahmed, S., Li, Q., Liu, L., dan A. O Tsui. n.d. “Maternal deaths averted by contraceptive use: an analysis of 172 countries.” The Lancet 380 (9837): 111–25.

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BKKBN, Kemenkes, dan USAID. 2013. “Indonesia Demographic Health Survey (SDKI).” Jakarta.

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Blanc, A. K. 2001. “The effect of power in sexual relationships on sexual and reproductive health: an examination of the evidence.” Studies in family planning 32 (3): 189–213.

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Bongaarts, J., & Sinding, S. W. 2009. “A response to critics of family planning programs.” International Perspectives on Sexual and Reproductive Health 35 (1): 39–44.

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Do, M., dan N Kurimoto. 201M. “Women’s empowerment and choice of contraceptive methods in selected African countries.” International perspectives on sexual and reproductive health, 23–33.

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Govindasamy, P., dan A Malhotra. n.d. “Women’s position and family planning in Egypt.” Studies in Family Planning, 328–40.

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Hameed, W., S. K. Azmat, Ali M., M. I. Sheikh, G. Abbas, M Temmerman, dan B. I Avan. 2014. “Women’s empowerment and contraceptive use: the role of independent versus couples’ decision-making, from a lower middle income country perspective.” PloS one 9 (8): e104633.

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Patrikar, S. R., D. R. Basannar, dan M. S Sharma. 2014. “Women empowerment and use of contraception.” medical journal armed forces India 70 (3): 253–56.

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Riyami, A. Al, M. Afifi, dan R. M Mabry. 2004. "Women's autonomy, education, and employment in Oman and their influence on contraceptive use." Reproductive health matters 12 (23): 144–54.

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World Health Organization. 1996. "Mother-baby package: implementing safe motherhood in countries: a practical guide." https://www.adb.org/sites/default/files/publication/28917/health-id.pdf.

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