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).
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.
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.
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).
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.
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.
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.