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ORCID ID

Dewi Nuryana : 0000-0003-3006-6724

Restu Adya Cahyani : 0000-0003-4066-2183

Sukma Rahayu : 0000-0002-8282-7073

Nohan Arum Romadlona : 0000-0003-3799-0928

Elvira Liyanto : 0000-0003-0108-1546

Lovely Daisy : -

Wira Hartiti : -

Maria Evi Ratnawati : -

Budi Utomo : 0000-0002-8733-5975

Robert Joseph Magnani : 0000-0002-2666-1371

Abstract

Background: The unmet need for family planning in Indonesia has been stagnant since the early 2000s in the 10%–12% range with substantial socioeconomic and geographic disparities. This study sought to better understand the factors underlying the nonuse of contraceptives among women with an apparent need for family planning so that evidence-based corrective actions can be taken.

Methods: Three sources of quantitative data were used in the study—the 2017 Indonesia Demographic Health Survey, the 2018 Village Potential Survey, and the National Population and Family Planning Board service statistics. Further insights were obtained from online focus group discussions and in-depth interviews with participants in 12 districts/cities in seven provinces.

Results: The analyses indicated that health concerns, service delivery-related factors, and opposition to family planning all contribute to the unmet need for family planning in Indonesia. Importantly, the salience of these factors varied significantly across different subgroups of women and geographic areas.

Conclusions: Successful efforts to reduce the unmet need for family planning are complex in that they must contend with the interplay between local sociocultural contexts, individual beliefs/aspirations/preferences, and the supply environment of family planning services. Differentiated interventions for different population subgroups and geographic areas will be needed.

References

  1. Westoff CF. Is the KAP-Gap Real? Popul Dev Rev. 1988;14:225–32.
  2. Bradley SEK, Croft TN, Fishel JD, Westoff CF. Revising unmet need for family planning. DHS Analytical Studies No. 25. Calverton, Maryland, USA: ICF International; 2012.
  3. Rothschild CW, Brown W, Drake AL. Incorporating method dissatisfaction into unmet need for contraception: Implications for measurement and impact. Stud Fam Plann. 2021;52:95–102.
  4. Rominski SD, Stephenson R. Toward a new definition of unmet need for contraception. Stud Fam Plann. 2019;50:195–8.
  5. Center for Reproductive Rights. Reproductive Rights are Human Rights. New York, United States; 2009.
  6. Hardee K, Kumar J, Newman K, Bakamjian L, Harris S, Rodríguez M, et al. Voluntary, human rights-based family planning: A conceptual framework. Stud Fam Plann. 2014;45:1–18.
  7. Erdman NJ, Cook JR. Reproductive Rights. In Heggenhougen HK, Quah S. Eds. International Encyclopedia of Public Health. Academic Press, 2008, p. 532–8.
  8. Cottingham J, Germain A, Hunt P. Use of human rights to meet the unmet need for family planning. Lancet. 2012;380:172–80.
  9. Susheela S, Darroch JE, Ashford LS. Adding it up: The costs and benefits of investing in sexual and reproductive health 2014. New York: Guttmacher Institute; 2014.
  10. Ahmed S, Li Q, Liu L, Tsui AO. Maternal deaths averted by contraceptive use: An analysis of 172 countries. Lancet. 2012;380:111–25.
  11. Sedgh G, Ashford LS, Hussain R. Unmet need for contraception in developing countries: Examining women’s reasons for not using a method. New York: Guttmacher Institute; 2016.
  12. Adebowale SA, Palamuleni ME. Determinants of unmet need for modern contraception and reasons for non-use among married women in rural areas of Burkina Faso. Afr Popul Stud. 2014;28:499–514.
  13. Hailemariam A, Haddis F. Factors affecting unmet need for family planning in southern nations, nationalities and peoples region, ethiopia. Ethiop J Health Sci. 2011;21:77–89.
  14. Islam AZ, Mostofa MG, Islam MA. Factors affecting unmet need for contraception among currently married fecund young women in Bangladesh. Eur J Contracept Reprod Health Care. 2016;21:443–8.
  15. Woldemicael G, Beaujot R. Currently married women with an unmet need for contraception in Eritrea: Profile and determinants. Can Stud Popul. 2011;38:61–81.
  16. Imasiku EN, Odimegwu CO, Adedini SA, Ononokpono DN. Variations in unmet need for contraception in Zambia: Soes ethnicity play a role? J Biosoc Sci. 2014;46:294–315.
  17. Dutta M, Shekhar C, Prashad L. Level, trend and correlates of mistimed and unwanted pregnancies among currently pregnant ever married women in India. PLoS One. 2015;10:e0144400.
  18. Oginni AB, Ahonsi BA, Adebajo S. Trend and determinants of unmet need for family planning services among currently married women and sexually active unmarried women aged 15-49 in Nigeria (2003—2013). Afr Popul Stud. 2015;29:1483–99.
  19. Wulifan JK, Brenner S, Jahn A, De Allegri M. A scoping review on determinants of unmet need for family planning among women of reproductive age in low and middle income countries. BMC Womens Health. 2016;16:2.
  20. Bellizzi S, Sobel HL, Obara H, Temmerman M. Underuse of modern methods of contraception: Underlying causes and consequent undesired pregnancies in 35 low- and middle-income countries. Hum Reprod. 2015;30:973–86.
  21. Njotang PN, Yakum MN, Ajong AB, Essi MJ, Akoh EW, Mesumbe NE, et al. Determinants of modern contraceptive practice in Yaoundé-Cameroon: A community based cross sectional study. BMC Res Notes. 2017;10:219.
  22. Ndaruhuye DM, Broekhuis A, Hooimeijer P. Demand and unmet need for means of family limitation in Rwanda. Int Perspect Sex Reprod Health. 2009;35:122–30.
  23. Ali AA, Okud A. Factors affecting unmet need for family planning in Eastern Sudan. BMC Public Health. 2013;13:102.
  24. Lakew Y, Reda AA, Tamene H, Benedict S, Deribe K. Geographical variation and factors influencing modern contraceptive use among married women in Ethiopia: Evidence from a national population based survey. Reprod Health. 2013;10:52.
  25. Amoako Johnson F, Madise NJ. Examining the geographical heterogeneity associated with risk of mistimed and unwanted pregnancy in Ghana. J Biosoc Sci. 2009;41:249–67.
  26. Adhikari R, Soonthorndhada K, Prasartkul P. Correlates of unintended pregnancy among currently pregnant married women in Nepal. BMC Int Health Hum Rights. 2009;9:17.
  27. Tiruneh FN, Chuang KY, Ntenda PA, Chuang YC. Factors associated with contraceptive use and intention to use contraceptives among married women in Ethiopia. Women Health. 2016;56:1–22.
  28. Genet E, Abeje G, Ejigu T. Determinants of unmet need for family planning among currently married women in Dangila town administration, Awi Zone, Amhara regional state; A cross sectional study. Reprod Health. 2015;12:42.
  29. Nzokirishaka A, Itua I. Determinants of unmet need for family planning among married women of reproductive age in Burundi: A cross-sectional study. Contracept Reprod Med. 2018;3:11.
  30. Wablembo MS, Ntozi J, Kwagala B. Does couple discussion influence unmet need for family planning in Uganda. Paper presented at: Sixth African Population Conference; 2011 December 5-9; Ouagadougou, Burkina Faso.
  31. Asif MF, Pervaiz Z. Socio-demographic determinants of unmet need for family planning among married women in Pakistan. BMC Public Health. 2019;19:1226.
  32. Alam ME, Bradley J, Shabnam F. IUD Use and Discontinuation in Bangladesh. New York: International Household Survey Network, 2007.
  33. Utomo B, Rahayu S, Romadlona NA, Nuryana D, Aryanty RI, Liyanto E, et al. The Indonesia National Family Planning Program: Progress and Remaining Challenges in Implementing a Rights-Based Approach. Jakarta: Knowledge Hub for Reproductive Health Indonesia, 2022.
  34. Statistics Indonesia (Badan Pusat Statistik). Profil Penduduk Indonesia Hasil SUPAS. Jakarta: Badan Pusat Statistik, 2015.
  35. Indonesian Ministry of National Development Planning/National Development Planning Agency (Bappenas). Rencana Pembangunan Jangka Menengah Nasional (RPJMN) 2020-2024. Jakarta: Bappenas, 2019.
  36. Aryanty RI, Romadlona N, Besral B, Panggabean EDP, Utomo B, Makalew R, et al. Contraceptive use and maternal mortality in Indonesia: A community-level ecological analysis. Reprod Health. 2021;18:42.
  37. National Population and Family Planning Board (BKKBN), Statistics Indonesia (BPS), Ministry of Health (Kemenkes), and ICF. Indonesia Demographic and Health Survey 2017. Jakarta: BKKBN, BPS, Kemenkes, and ICF, 2018.
  38. Rahayu S, Romadlona NA, Utomo B, Aryanty RI, Liyanto E, Hidayat M, et al. Reassessing the Level and Implications of Male Involvement in Family Planning in Indonesia. Jakarta: Knowledge Hub for Reproductive Health Indonesia, 2022.
  39. Greene ME, Mehta M, Pulerwitz J, Wulf D, Bankole A, Singh S. Involving men in reproductive health: Contributions to development. New York: United Nations Millennium Project, 2006.
  40. Track20. The method information index. Connecticut: Track20, 2017.
  41. Liyanto E, Nuryana D, Cahyani RA, Utomo B, Magnani R. How well are Indonesia's urban poor being provided access to quality reproductive health services? PLoS One. 2022;17:e0265843.
  42. Wilopo SA, Setyawan A, Pinandari AW, Prihyugiarto T, Juliaan F, Magnani RJ. Levels, trends and correlates of unmet need for family planning among postpartum women in Indonesia: 2007-2015. BMC Womens Health. 2017;17:120.

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