Contraception Methods Selection Behavior Among Female Contraception Users

ABSTRACT

others, one of most used contraception method in Pekanbaru is 3-month hormonal injection (29.

63%) (3).
Three-month hormonal injection is more beneficial to use because its convenient, accesible, with less side effects (4). Long term contraception method such as Intra Uterine Devices (IUD), tubal ligation, were less favourable because the examination, application technique, and a major surgery it needed (5). Considerating benefits and inadequacy of each contraception methods when applied, based on users medical condition, perception and interpretation, is fundamental to determine contraception method applied. Several factors to considerate is users demographic characteristic, disesases risk, side effects profile, expenses, equipment availability, and patient preference (6). World Health Organization construct Medical Eligibility Criteria for contraceptive use (MEC) to facilitate family planning users determining safe and appropriate method. MEC consist of 4 category, using ranking system based on degree of restriction of particular method. Category 1 where there is no restriction for use (use any method), category 2 where the advantages of using the method generally outweigh the theoretical or proven risks (generally use the method), category 3 where the theoretical or proven risks usually outweigh the advantages of using the method (Use of method not usually recommended unless other more appropriate methods are not available or not acceptable), category 4 represents an unacceptable health risk if the contraceptive method is used ( method not be used) (7).
Indonesia Health Ministry arranging instrumental tools to facilitate family planning users determining safe and appropriate method based on MEC, Alat Bantu Pengambilan Keputusan Ber-KB (ABPK). This tools contains guideline for health care professional to deliver contraception methods counseling, consist of information needed such as side effects, contraception method application, condition consideration for contraception method application, and eligibility critera.
ABPK is color coded flipbook, green for new user, pink for user with sexual transmitted diseases protection need, blue for special needed user, and purple for old user (8).
Becker (1979) classify health behavior into 3 category, healthy lifestyle, illness behavior, the sick role behavior. Healthy lifestyle including how to maintain health and wellness. Illness behavior is about how a person responding to sickness, diseases, including individual perception, knowledge, and attitude toward sickness and diseases. The sick role behavior is about how people act in seek of the cure, including patient rights and obligations. Behavior occur actively and passively. Active behavior is an observed respond in form of tangible behavior, while passive behavior is an internal respond in form of intangible behavior such as knowledge and attitude (6) Research about contraception method selection behavior mainly focus on selecting single method (9) (10) (11). Eventhough at the beginning of selection process, meanwhile, family 10.12928/promkes.v4i2.5875 planning users must aware of all contraception method (6). Through counseling process, family planning users were expected to selecting appropriate contraception methods. The fact is, most used method is hormonal injection method despite users medical condition, benefits, inadequacy, diseases risk, side effect profile (1). This research aim to describe contraception method selection behavior, considerating family planning users suitability with MEC.

Method
Research were using descriptive observational study design. Sample size is 400, calculated

Results and Discussion
Demographically, majority research subject (45%) were in age group 30-39 years old, mostly with educational attainment high school (51%), and occupation as housewives (80%). A research concluded age group, educational status (including husband educational status), number of living children, wealth status, significantly associated with knowledge, attitude and practice of family planning users (13). While education, occupation, and total income ,associated with knowledge regarding contraception, thus it associated to selection methods behavior (14).

Users Contraception Methods and Appropriateness
Similar to Kementerian Kesehatan Republik Indonesia (2020) data, majority respondent (37%) were using 3 month hormonal injection method, it also resembling Liwang et al (2018) research. Hormonal injection and pills were popular because it accessibility, safe for breastfeeding, not interfere sexual intercourse (15). The following data is presented in Figure 1 below:

Figure 1. Contraception Methods Used.
Each subject were assesed with MEC to observed contraception method chosen by subject appropriate with their condition. The result, there is 63% subject using appropriate contraception methods, while there is still 37% subject using unappropriate contraception methods. The following data is presented in Figure 2 below:

Figure 2. Contraception Methods Appropriateness with MEC
Family planning services include informed choice decision making for selecting contraception methods. Counseling were one form of "informed", counseling given by healthcare profesionnal for family planning users whom intend to use contraception. Counseling help family planning users to choose appropriate method, with consideration on medical eligibility and convenient ( World Health Organization,2016). Convenient means , chosen method appropriate with contraception purpose (stopping pregnancy, medical condition), methods practice, side effects or 10.12928/promkes.v4i2.5875 other discomfort from prior method. MEC is an instrument to help health profesional determine methods appropriate based on benefit and disadvantage for users. If benefit greater than disadvantage, users could use the methods (crietria 1 and 2), if disadvantage greater than benefit, users should choose other methods (criteria 3 and 4) (7)

Contraception Methods Selection Behavior
Data analysis showed majority subject had improper behavior (244 from 400 subjects, 61%), followed by moderate behavior (104 from 400 subjects, 26%), and proper behavior ( 52 from 400 subjects,13%). Behavior in this research observed by subject reason for choosing contraception method, subject MEC, and appropriateness for both. Behavior categorized into improper (<34%), moderate (35-66%), and proper behavior (>67%). The following data is presented in Figure 3 below: Demographically, majority research subject (45%) were in age group 30-39 years old, mostly with educational attainment high school (51%), and occupation as housewives (80%). A research concluded age group, educational status (including husband educational status), number of living children, wealth status, significantly associated with knowledge, attitude and practice of family planning users (13). While another research stated that education, occupation, and total income ,associated with knowledge regarding contraception (19).
Female age above 30 years old mostly using contraception to stop pregnancy, therefore longterm methods such as implant, IUD, tubectomy, should be main choices (20). Yet, hormonal injection and pills were main chosen methods. High school educational attainment is advanced enough, at this level a person should have sufficient prior knowledge to receive information about contraception methods. Accordingly, subject should have moderate or proper behavior. Fact is, majority subjects had improper behavior of contraception methods selection. Therefore, it is a probability ,contraception methods selection behavior were affected by other factors. Occupation as housewives, with flexible hours, allow subjects to access healthcare facillity more than working one (19). Therefore, subjects should have moderate or proper behavior instead improper.  users were using hormonal pills method, followed by 3 month hormonal injection method . Pills were shortest term of hormonal method, it had lowest effectivity among other hornonal methods.
Bukit Raya had adequate resources for family planning services, although majority users were choosing pills method despite of it lowest effectivity, this probably linked to no users with proper behavior (25).
The following is the data on moderate behavior in the method of choosing contraception by district as shown in Figure 5 below:  (26). Here we present data related to the behavior of selection of improper contraception methods by district in figure 6 below:

Figure 6. Improper Behavior of Contraception Selection Methods by Districts
Improper behavior were highest in Tampan district ( Rumbai is second most sparsely populated district). Most family planning users (52.15%) is using 3-month hormonal injection method. In conclusion, Sukajadi had more resources than other districts in Pekanbaru, with lower registered family planning users. Similar to Rumbai, there is high possibility it had better qualified family planning services than other districts, even Rumbai (28).
By districts, improper behavior were highest in Tampan, most populated district with one most highest family planning users number. Meanwhile, proper behavior were highest in Pekanbaru Kota and Payung Sekaki. Pekanbaru Kota were most densely populated district ( 2 times higher from Tampan), but with family planning users only one quarter from Tampan. Payung Sekaki were widest district but with very sparse population ( one fifth from Pekanbaru kota). All districts were supported with sufficient resources for family planning services, each district had minimum one 10.12928/promkes.v4i2.5875 primary public health centre, at least 4 clinics, and adequate number of doctors, nurses and midwives. This research only describe contraception selection methods behavior among female users, along with several demographic characteristics. Nevertheless, further research were needed to explore the results, to get a better view about contraception methods selection behavior among female contraception users.