gender perceptions on contraception among couples of childbearing age in jatinangor, sumedang

8/18/2019 Gender Perceptions on Contraception Among Couples of Childbearing Age in Jatinangor, Sumedang

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GENDER PERCEPTIONS ON CONTRACEPTION AMONG COUPLES

OF CHILDBEARING AGE IN JATINANGOR, SUMEDANG:

A COMPARATIVE STUDY

Dea Natalia1, Dini Pusianawati

2, Irvan Afriandi

3

1Faculty of Medicine, Universitas Padjadjaran,

2Dept. of Obstetric and

Gynecology, Hasan Sadikin General Hospital, 3Dept. of Public Health, Faculty of

Medicine, Universitas Padjadjaran

1. Dea Natalia

Faculty of Medicine, Universitas Padjadjaran

Jalan Raya Bandung-Sumedang Km. 21

Jatinangor, Sumedang, IndonesiaTelepon: +62 81519173322

Email: [email protected]

2. Dini Pusianawati, dr., SpOG(K)

Department of Obstetric and Gynecology

Hasan Sadikin General HospitalJalan Pasteur No.38

Bandung, IndonesiaTelepon: +62 811225795


3. #$%&' ()$*&'+*, +$-, .$- /0

Department of Public Health

Faculty of Medicine, Universitas Padjadjaran

Jalan Raya Bandung-Sumedang Km. 21

Jatinangor, Sumedang, Indonesia

Telepon: +62 81320395588



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Abstract

Background. Contraception use among couples of childbearing age is an

important part of family planning. Gender differences on family planning areshown by lack of male participants in contraception use. Studies showed that

perception is one of the factors that influence one’s participation in various

subjects. In this study, knowledge and perception level between males andfemales among couples of childbearing age were compared to see whether there

were significant differences between the two.

Method. A quantitative cross-sectional analytic survey was conducted using an

interviewer-administered questionnaire on knowledge and perception about

contraception. 154 respondents or 77 couples of childbearing age were recruited

to participate from 12 villages in Jatinangor district, Sumedang, with multistage

sampling method from September-November 2014. Analysis of knowledge and perception levels was done with SPSS Statistical 20.

Results. Contraception use among females was high (74.02% from total female

respondents, 37.01% from total respondents) while use among males wasconsiderably lower, only 2.59% from total male respondents or 1.29% from total

respondents. Mean knowledge and perception scores were higher in females ascompared to the males. Certain differences between males and females are noted

(Knowledge on IUD p


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Abstrak

Latar Belakang. Penggunaan alat kontrasepsi di kalangan pasangan usia subur

adalah bagian penting dalam program keluarga berencana. Ketimpangan genderdalam program keluarga berencana ditunjukkan oleh rendahnya partisipasi priadalam penggunaan alat kontrasepsi. Penelitian menunjukkan persepsi adalah salah

satu faktor yang mempengaruhi partisipasi seseorang dalam berbagai kegiatan.Dalam penelitian ini, pengetahuan dan persepsi pria dan wanita mengenai alat

kontrasepsi di kalangan pasangan usia subur dibandingkan untuk melihat adanya perbedaan yang signifikan diantara keduanya

Metode, Survei analitik kuantitatif potong lintang dilaksanakan dengan kuesioner

tentang pengetahuan dan persepsi mengenai alat kontrasepsi. Sampel sebanyak

154 responden atau 77 pasangan usia subur diperoleh dari 12 desa di kecamatan

Jatinangor, Sumedang, dengan metode sampling gugus bertahap pada September- November 2014. Analisa pengetahuan dan persepsi dilakukan denganmenggunakan SPSS Statistical 20.

Hasil. Tingkat penggunaan alat kontrasepsi pada wanita tinggi (74.02% dari total

responden wanita, 37.01% dari total responden) sedangkan tingkat penggunaan pada pria lebih rendah, hanya 2.59% dari total responden pria atau 1.29% dari

total responden. Rata-rata nilai pengetahuan dan persepsi lebih tinggi pada wanita

dibandingkan dengan pria. Perbedaan pada nilai antara pria dan wanita terlihat

pada pengetahuan mengenai IUD (p


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Background

Family planning in Indonesia is taken into account by Badan Kependudukan dan

Keluarga Berencana Nasional (BKKBN). Originally, family planning was

directed more on demographical aspect with focus on decreasing fertility and

population rate. However, ever since International Conference on Population and

Development (ICPD) 1994 took place, there was a change of paradigm in family

planning, focusing more on reproductive rights and gender equality1.

Contraception is expected to be used both by male and female spouses of

couple of childbearing age. Ideally, the use of contraception should be a shared

responsibility2. However, as reported by BKKBN Bandung and Unit Pelaksana

Teknis Badan Keluarga Berencana (UPTB KB) Jatinangor, contraception use was

still dominated by female participants3. This condition highlighted the fact that

there were gender differences regarding contraception use.

Gender differences in contraception use is furthermore elaborated in other

studies. One study discussed that one of the reason there was lack of male

contraception use is because there is a tradition or habit in the community to

delegate the task of family planning to the women4. A previous study also showed

gender bias in terms of contraception use among couples of childbearing age. One

of the factors discussed in the study was gender ideology, in which contraception

use is regarded as one of women’s roles in the community5. These gender

discrepancies cause inequalities in terms of reproductive rights and health,

especially for women. An increase of participation in contraception use by men is


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necessary to elevate reproductive health both in women and men, gender equality,

and subsequently, increased quality of contraception providers6

.

Knowledge is related to perception. Better understanding of certain

subjects would cause people to have more readiness to accept it. This notion is

often referred to as perceptual set. Basically, it is the tendency to perceive or

notice some aspects of the available sense data and ignore others. Liew summed

up that knowledge is a mixture of data and information acquired by an individual,

involves the belief and experiences of the individual and strongly tied to one’s

action7.

Meanwhile, perception is the process by which organism interpret and

organize sensation to produce a meaningful experience of the world8. In other

words, perception is defined as an act of being aware of one’s environment, which

denotes an individual’s ability to understand. Thus, perception explains why

certain person acts or behaves in a different way from other person and interprets

stimuli differently although it was experienced similarly9. Studies showed that

perception is one of the factors that influence one’s participation in various

subjects10, 11. Thus, it can be inferred that higher level of participation is related to

higher level of knowledge and overall better perception.

The aim of the study presented in this article was to compare knowledge

about and perceptions of contraception between males and females among couples

of childbearing age in Jatinangor, Sumedang, to see whether there were

significant differences between the two.


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Methods

This study was designed as a cross sectional, observational survey. The Health

Research Ethics Committee Universitas Padjadjaran approved this study in

September 5th, 2014 (No. 285/UN6.C2.1.2/KEPK/PN/2014). Before the

questionnaires were given, a written informed consent form regarding the method,

purpose, and meaning of this survey was provided to the respondents. If the

respondents wished to take part in the survey, they were asked to affix their

signatures on the page. Written informed consent forms were obtained from all

respondents prior to the investigation.

Subjects of the study

The criteria for eligible participants were as follows: (1) couples of childbearing

age with the female aged 15 to 49 years, (2) residing at one out of 12 villages in

Jatinangor, and (3) can provide written informed consent. The excluding criteria

were: (1) the inability to be contacted by interviewer and (2) failure to finish

answering the study questionnaire.

Sampling strategy

12 administrative zones were each selected out of the 12 villages in Jatinangor

district, Sumedang from September to October 2014. One community was

randomly selected from each zone. Subjects were randomly recruited from each

community. Respondents following the research was up to 166 individuals, or 83

couples of childbearing age; with 77 couples fulfilled inclusion criteria, passing


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the 38 couples minimum samples criteria; while 6 couples either decline to

continue their participation in this study or unable to finish answering the

questionnaires.

Statistical methods

A questionnaire, prepared in the Indonesian language, was administered to each

study participant after previously validated using statistical software SPSS version

20, with a total of 58 questions on knowledge and 70 questions on perceptions.

This questionnaire sought to obtain information on socio-demographic

characteristics, knowledge and perceptions on various contraception. Knowledge

was scored with Guttman scale while perception was scored with Likert scale.

To test the statistical significance between groups, Wilcoxon signed-rank

test was used for measurement variables and chi-square test was used for

categorical variables. The inclusion P value was 0.05. Statistical software SPSS

version 20 was utilized to perform the statistical analyses.

Results

Table 1 shows the demographic of the respondents. A total of 77 couples or 154

respondents were examined. The majority of male respondents age was 36-49

years old, while the females’ was mostly 21-35 years old. Both male and female

respondents had mostly completed their education up to senior high level,

however there were still female respondents who did not graduate from primary

school. Most male respondents were employed as private employees, while the


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female respondents were mostly formally unemployed. The average monthly

income of the couples of childbearing age was less than 1 million rupiahs, which

was lower than Sumedang district Minimum Wage Standard of 1,735 million

rupiahs. Regarding the age at which the male and female respondents were first

married; the male respondents were mostly married at age 21-35 years old, while

the females were mostly married under 21 years of age. Almost all respondents

are in their first marriage, with only 4 men and 3 women stating that the marriage

they are currently in is not their first marriage.

Table 2 shows the types of contraception known and ever used by the

respondents. Injectables was the type of contraception commonly known

(94.15%), followed by pills (82.46%), while the least commonly known

contraception was the rhythm (calendar) method (3.89%). The proportion of the

type of contraception most commonly used reflected the type of contraception

known. The most commonly used type of contraception by the female

respondents was injectables (29.87%), followed by pill (14.28%). Meanwhile,

only 2 respondents out of 77 male respondents were using contraception. The type

of contraception used by the male respondents was vasectomy. It was also

observed that there were still respondents who were not using contraception,

consisting of 20 female respondents (25.97%) and 75 male respondents (97.40%),

adding up to 95 respondents or about 61.68% of total respondents.


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Table.1 Socio-demographic Characteristics

Male (n=77) Female (n=77) Total (n=154)

Age (years)

! 20 - 2 (2.59%) 2 (1.29%)

21-35 28 (36.36%) 41 (53.24%) 69 (44.80%)

36-49 44 (57.12%) 34 (44.15%) 78 (50.64%)

" 50 5 (6.49%) - 5 (3.24%)

Highest education level

part primary - 2 (2.59%) 2 (1.29%)

completed primary 20 (25.97%) 11 (14.28%) 31 (20.12%)

completed junior high 21 (27.27%) 30 (38.96%) 51 (33.11%)

completed senior high 31 (40.25%) 32 (41.55%) 63 (40.90%)

bachelor degree and higher 5 (6.49%) 2 (2.59%) 7 (4.54%)

Employment status

labor 10 (12.98%) 1 (1.29%) 11 (7.14%)

farmer 8 (10.38%) - 8 (5.19%)

government employee 3 (3.89%) 1 (1.29%) 4 (2.59%)

private employee 31 (40.25%) 8 (10.38%) 39 (25.32%)

entrepreneur 23 (29.87%) 5 (6.49%) 28 (18.18%)

unemployed 2 (2.59%) 62 (80.51%) 64 (41.55%)

Monthly income

< 1 million rupiahs 38 (49.35%) 38 (49.35%) 76 (49.35%)

1 – 3 million rupiahs 33 (42.85%) 28 (36.36%) 61 (39.61%)

> 3 million rupiahs 6 (7.79%) 11 (14.28%) 17 (11.03%)

Age at first marriage (years)

! 20 8 (10.38%) 46 (59.74%) 54 (35.06%)

21-35 67 (87.01%) 31 (40.25%) 98 (63.63%)

36-49 1 (1.29%) - 1 (0.64%)

" 50 - - -

unspecified 1 (1.29%) - 1 (0.64%)

Number of previous marriages

0 73 (94.80%) 74 (96.10%) 147 (95.45%)

" 1 4 (5.19%) 3 (3.89%)


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Table.2 Types of Contraception Known and Used

Male (n=77) Female (n=77) Total (n=154)

Contraception Known

injectables 70 (90.90%) 75 (97.40%) 145 (94.15%)

pill 63 (81.81%) 64 (83.11%) 127 (82.46%)

implant 37 (48.05%) 49 (63.63%) 86 (55.84%)

IUD 36 (46.75%) 52 (67.53%) 88 (57.14%)

tubal ligation 15 (19.48%) 29 (37.66%) 44 (28.57%)

vasectomy 14 (18.18%) 24 (31.16%) 38 (24.67%)

rhythm/calendar method 5 (6.49%) 1 (1.29%) 6 (3.89%)

withdrawal method 8 (10.38%) 3 (3.89%) 11 (7.14%)

condom 37 (48.05%) 39 (50.64%) 76 (49.35%)

others 1 (1.29%) - 1 (0.64%)

Current Contraception Use

injectables - 23 (29.87%) 23 (14.93%)

pill - 11 (14.28%) 11 (7.14%)

implant - 4 (5.19%) 4 (2.59%)

IUD - 7 (9.09%) 7 (4.54%)

tubal ligation - 5 (6.49%) 5 (3.24%)

vasectomy 2 (2.59%) - 2 (1.29%)

rhythm/calendar method - - -

withdrawal method - - -

condom - - -

others/unspecified - 7 (9.09%) 7 (4.54%)

not using contraception 75 (97.40%) 20 (25.97%) 95 (61.68%)

Table 3 presents the findings on contraception knowledge among the couples.

Compared with the female respondents, the male respondents generally had lower

mean score on knowledge, except on knowledge on condom (3.51 vs. 3.31).

Statistical test for knowledge difference on IUDs elicit a statistically significant

result (Z = -3.609, p < 0.001). Median knowledge rating for males was 4 and for

females was 5.


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Table.3 Knowledge on Contraception

Male Female Statistics

Condom

maximum (6) 6 6 Z = -0.930

minimum 0 0 p = 0.35

mean ± SD 3.51 ± 1.984 3.31 ± 1.948

median ± IQR 4 ± 3 4 ± 3

Vasectomy

maximum (3) 3 3 Z = -1.550


mean ± SD 0.71 ± 0.998 0.91 ± 1.041

median ± IQR 0 ± 2 0 ± 2

Tubal Ligation

maximum (5) 5 4 Z = -1.425


mean ± SD 1.27 ± 1.699 1.58 ± 1.641

median ± IQR 0 ± 3 1 ± 3

Injection

maximum (10) 10 10 Z = -1.110


mean ± SD 5.09 ± 3.208 5.38 ± 2.734

median ± IQR 5 ± 5 5 ± 4

Pill

maximum (12) 12 12 Z = -1.853


mean ± SD 5.09 ± 3.297 5.61 ± 2.691

median ± IQR 4 ± 5 6 ± 4

Traditional (rhythm/calendar method, withdrawal method)

maximum (7) 7 7 Z = -1.609


mean ± SD 3.22 ± 2.674 3.74 ± 2.707

median ± IQR 3 ± 6 4 ± 6

IUD

maximum (10) 10 10 Z = -3.609

minimum 0 0 p < 0.001

mean ± SD 3.18 ± 2.905 4.40 ± 2.988

median ± IQR 4 ± 5 5 ± 4

Implant

maximum (5) 5 5 Z = -1.703


mean ± SD 2.16 ± 1.885 2.57 ± 1.705

median ± IQR 2 ± 4 3 ± 3

* maximum score of each category is determined by maximum number of questions on each category


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Table.4 Likelihood of Having Knowledge on ContraceptionYes No Crude OR 95% CI Statistics

Condom p = 0.74Female 39 38 1.00

Male 37 40 0.901 (0.479, 1.696)

Vasectomy p = 0.062

Female 24 53 1.00

Male 14 63 0.491 (0.231, 1.043)

Tubal Ligation p = 0.013

Female 29 48 1.00

Male 15 62 0.400 (0.193, 0.830)*

Injection p = 0.086

Female 75 2 1.00

Male 70 7 0.267 (0.054, 1.327)

Pill p = 0.832Female 64 13 1.00

Male 63 14 0.914 (0.398, 2.099)

Rhythm (Calendar) Method p = 0.096

Female 1 76 1.00

Male 5 72 5.278 (0.602, 46.275)

Withdrawal Method p = 0.118

Female 3 74 1.00

Male 8 69 2.860 (0.729, 11.219)

IUD p = 0.009

Female 52 25 1.00

Male 36 41 0.422 (0.219, 0.812)*

Implant p = 0.051

Female 49 28 1.00

Male 37 40 0.529 (0.277, 1.007)

Table 4 shows significance on knowledge about contraception on couples of

childbearing age. Generally, women were significantly having more knowledge

on tubal ligation and IUD.

Table 5 presents the findings on perception score among the couples.

Compared with the female respondents, the male respondents generally had lower

perception score, except regarding IUD (18.26 vs. 18.04). Statistical test for

perception difference on Tubal Ligation elicit a statistically significant result (Z =

-2.888, p = 0.004). Median perception rating for males was 22 and for females

was 25.


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Table.5 Perception on Contraception

Male Female Statistics

Condom

maximum (60) 58 59 Z = -0.026

minimum (10) 10 10 p = 0.97

mean ± SD 28.99 ± 10.083 29.97 ± 11.574

median ± IQR 26 ± 15.50 27 ± 16.50

Vasectomy

maximum (30) 30 30 Z = -0.841

minimum (5) 5 5 p = 0.40

mean ± SD 16.53 ± 6.684 17.53 ± 6.088

median ± IQR 16 ± 11 18 ± 10

Tubal Ligation

maximum (42) 42 42 Z = -2.888

minimum (7) 7 9 p = 0.004

mean ± SD 22.38 ± 8.766 25.32 ± 8.136

median ± IQR 22 ± 14 25 ± 11.50

Depot/Injection

maximum (36) 35 36 Z = -0.761

minimum (6) 8 9 p = 0.44

mean ± SD 21.06 ± 5.327 21.87 ± 5.865

median ± IQR 21 ± 6 21 ± 7

Pill

maximum (36) 36 36 Z = -1.392

minimum (6) 10 10 p = 0.16

mean ± SD 24.90 ± 5.801 26.01 ± 5.454

median ± IQR 25 ± 8 26 ± 7

Traditional (rhythm/calendar method, withdrawal method)

maximum (30) 30 30 Z = -0.285

minimum (5) 5 5 p = 0.776

mean ± SD 18.05 ± 6.200 18.32 ± 6.233

median ± IQR 19 ± 9.50 19 ± 9

IUD

maximum (30) 30 30 Z = -0.446

minimum (5) 5 5 p = 0.656

mean ± SD 18.26 ± 5.807 18.04 ± 6.101

median ± IQR 20 ± 8 16 ± 9

Implant

maximum (24) 24 24 Z = -0.519

minimum (4) 4 8 p = 0.60

mean ± SD 15.90 ± 4.558 16.53 ± 4.521

median ± IQR16 ± 7 17 ± 6


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Social Norms

maximum (90) 78 79 Z = -1.227

minimum (15) 41 46 p = 0.22

mean ± SD 59.90 ± 8.210 61.01 ± 8.212

median ± IQR 60 ± 13 61 ± 12

Accessibility

maximum (42) 42 41 Z = -1.474

minimum (7) 12 12 p = 0.141

mean ± SD 30.01 ± 5.243 30.69 ± 5.413

median ± IQR 30 ± 4.50 32 ± 4

* maximum score is determined by maximum number of questions on each category

Table.6 Likelihood of Participation in Contraception UseYes No Crude OR 95% CI Statistics

Participation p < 0.001

Female 57 20 1.00

Male 2 75 0.009 (0.002, 0.042)

Table 6 shows significance on participation on contraception among couples of

childbearing age. Generally, women were significantly more likely to use

contraception than men.

Discussion

Findings show that the female respondents are younger, being married at earlier

age, and mostly unemployed. Considering the average of monthly income of the

respondents in this study, most of the couples in this study were of lower

socioeconomic status. The most commonly known and used type of contraception

by the respondents was injection, followed by pills. This trend in knowledge on

contraception and contraceptive use is consistent with those reported in

Indonesian Demographic and Health Survey (IDHS) 2012. The number of


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respondents. However, results show that there is lack of significant differences

regarding knowledge and perception level between the male and female

respondents.

The lack of differences in perceptions might be explained by the fact that

male respondents were more indifferent about contraception use, leading to a

‘yes’ attitude regarding the option of female contraception available for his

spouse, as long as his spouse experienced no adverse effect while using the

contraception.

On the other hand, lack of significant differences on knowledge and

perceptions between male and female respondents may indicate that indeed the

knowledge and perceptions about contraception of male respondents are similar to

that of the female’s. This may imply increased concern about contraception from

the male respondents. However, due to the substantial gap between the number of

men showing positive perceptions about contraception and the number of men

actually using contraception, this study could not explain why male participation

level regarding contraception was still low. Although, when compared, the

likelihood of men to use contraception was also much lower than women.

Future efforts must focus on further increasing both men’s and women’s

knowledge about contraception, as mean knowledge score for both men and

women were still less than 50% of total attainable score, except for condom,

injection, traditional method (rhythm and withdrawal method), and implant. The

objective of this effort was to prepare the couples to make a fully informed

method choice. The high number of couples of childbearing age with risk of


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having high-risk pregnancy highlight the need for further improved family

planning counseling for all couples, especially about safe, effective, and long-term

contraceptive options, such as IUD and tubal ligation.

Conclusion

There were no significant differences on knowledge and perceptions between

male and female respondents regarding contraception, except on knowledge about

IUD and perceptions about tubal ligation. The overall mean score for knowledge

for both men and women were lower than 50% of the attainable score; with the

women being more likely to score higher than men. Meanwhile, perception score

of both men and women were similarly quite high. Relating to participation in

contraception use, it was found that women were more likely to use contraception

compared to men.


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8- [@X*= (- TD@ *==>@ G) F@$O@F;*G'I =GB@ @+>O&;*G'&A *BFA*O&;*G'=-

\+>O&$@- 199"M29Y"]1ZI161R77-

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gender perceptions on contraception among couples of childbearing age in jatinangor, sumedang

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