Quality of family planning care and modern contraceptive use in Indonesia
1
Issued Date
2021
Copyright Date
2021
Resource Type
Language
eng
File Type
application/pdf
No. of Pages/File Size
x, 103 leaves : ill.
Access Rights
open access
Rights
ผลงานนี้เป็นลิขสิทธิ์ของมหาวิทยาลัยมหิดล ขอสงวนไว้สำหรับเพื่อการศึกษาเท่านั้น ต้องอ้างอิงแหล่งที่มา ห้ามดัดแปลงเนื้อหา และห้ามนำไปใช้เพื่อการค้า
Rights Holder(s)
Mahidol University
Bibliographic Citation
Thesis (Ph.D. (Demography))--Mahidol University, 2021
Suggested Citation
Nurjaeni, 1979- Quality of family planning care and modern contraceptive use in Indonesia. Thesis (Ph.D. (Demography))--Mahidol University, 2021. Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/114983
Title
Quality of family planning care and modern contraceptive use in Indonesia
Author(s)
Advisor(s)
Abstract
The utilization of modern family planning methods is a key pointer that mirrors universal access to reproductive health care. Fulfilling unmet needs for modern contraceptives may decrease maternal mortality by almost a third. Low modern contraceptive prevalence and high unintended childbearing pose substantial challenges for Indonesia in achieving sustainable development goals. Despite the fact that contraceptive behaviors are influenced by multiple and multilevel variables, studies on modern contraceptive use in Indonesia have concentrated on single-level and mostly individual and household variables, and less interest has been devoted to multilevel analysis that accounts for community and SDP characteristics that may affect a woman’s decision to use a modern contraceptive method. This research employed the 2016 PMA2020 survey to assess multilevel variables related to modern family planning method use among women of reproductive age in Indonesia. This study analyzed nationally representative data from the 2016 PMA2020 survey of 10,210 women in 372 communities (EAs) in Indonesia. Data from interviews of females and Service Delivery Point (SDP) of the 2016 Performance Monitoring and Accountability 2020 (PMA2020) survey were linked to generate a merged dataset comprising women’s individual, household, cluster, and SDP factors ($N$=10,210). The data were analyzed using a multilevel mixed-effects logistic regression model to assess the role of overall quality, structural quality, and process quality of family planning care and other factors in modern contraceptive utilization after adjustment for other covariates. Adjusted odds ratios and 95% CIs were analysed and interpreted. Modern contraceptive use among women of childbearing age was 42.3% in 2016. There were significant differences across communities (EAs) in how they included variables associated with modern FP adoption. Age, education, marital status, parity, residency, region, woman’s FP decision autonomy, community’s average ideal number of children, percentage of females dissatisfied with FP, and proportion of females visited by CHVs were significant factors for modern FP use after adjusting for multilevel characteristics. The quality of FP care was revealed to be a significant enabling factor for modern contraceptive use in Indonesia. The findings also showed evidence of the significant roles of structural and process quality FP care in modern contraceptive use. The key variables for structural quality were the number of modern methods provided, SDP supported CHWs, available water and electricity, and available skilled FP personnel, while the main factors for process quality were privacy and confidentiality of clients and the provision of post-partum services. Moreover, women with high autonomy in FP decisions, those who had free national/district health insurance, and those living in a community with a higher proportion of women visited by CHW also had higher odds of modern contraceptive usage than their counterparts. Yet, women who live in a community with a higher mean ideal number of children or a greater proportion of women citing personal/husband/religion opposition to FP that leads to dissatisfaction with FP, both had lower odds of modern contraceptive use than their counterparts. Modern contraceptive adoption among females aged 15-49 years was low in 2016. The findings expose the need to boost modern contraceptive usage and diminish inequalities across regions in Indonesia. The findings also indicate that an advancement in modern methods can be gained by improving the quality of family planning care. More precisely, improvement in structural and process quality in FP care will yield substantial growth in modern contraceptive use. Likewise, an enhancement in women’s FP decision autonomy and their level of education are other concerns to be addressed. Moreover, FP workers should also address prevailing cultural/traditional customs in the community and should target communities where the demand for modern FP is deprived by social beliefs and norms. Overall, family planning policies must tackle adverse cultural norms and inequities in the quality of family planning care and women’s education that would cause harm to women, children, and communities. Yet, findings from multilevel mixed-effect regression analysis have demonstrated that there was significant variation across communities (EAs) in how individual, household, community, and SDP factors affect modern FP practice. Hence, context should be taken into consideration in the development of FP intervention and promotion programs.
Degree Name
Doctor of Philosophy
Degree Level
Doctoral degree
Degree Department
Institute for Population and Social Research
Degree Discipline
Demography
Degree Grantor(s)
Mahidol University