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Purpose: Women's needs for contraception during breastfeeding is a contraceptive that is safe to use during breastfeeding. The use of contraception in Indonesia in 2016 is dominated by hormonal contraceptives. Combined hormonal contraception, especially those containing estrogen and progesterone, is one of the causes that interferes with the breastfeeding process by inhibiting prolactin, thereby reducing the production of breast milk and impacting breastfeeding coverage. This study aims to know the description of the effect of using hormonal contraception on weaning time. Method: This study used cross sectional design by using secondary data of Performance Monitoring and Accountability (PMA2020) Indonesia 2016, and analyzed by retrospective cohort. The study was conducted on women who had the last child born 5 years before the survey and breastfed, using contraception after giving birth with sample size 982 respondents. Kaplan-meier curve is used to see the probability of survival in the length of breastfeeding, statistical test log-rank to determine the relationship between each variable with the dependent variable. Multivariable analysis using cox regression. Results: There was a significant correlation between the use of hormonal contraception and breastfeeding status. Early weaning was found in women who used 1-month injectable hormonal contraception, HR 2.50 [1,31-4,76]. Education level, economic status and area of residence were associated with weaning pvalue

Latar belakang: Lebih dari 95% ibu pasca persalinan ingin menunda kehamilan berikutnya atau tidak ingin hamil lagi namun tidak menggunakan kontasepsi sehingga terjadi unintended pregnancy yang berakhir pada kehamilan berisiko maupun unsafe abortion. Konseling tentang KB pada masa kehamilan dapat memenuhi kebutuhan kontrasepsi ibu pasca persalinan. Penelitian ini bertujuan untuk menganalis pengaruh konseling KB menggunakan ABPK terhadap penggunaan kontrasepsi pasca persalinan.Metode: Jenis penelitian eksperimen dengan desain randomized controlled trials. Populasi penelitian adalah ibu hamil yang memeriksakan kehamilan di Puskesmas Kota Yogyakarta. Sampel diperoleh secara acak yang memenuhi kriteria inklusi dan eksklusi. Variabel bebas berupa intervensi konseling KB menggunakan ABPK. Variabel terikat berupa penggunaan kontrasepsi pasca persalinan. Analisis bivariabel menggunakan uji chi square dengan signifikansi p-value < 0.05 dan analisis multivariabel menggunakan regresi logistik. Hasil: Proporsi penggunaan kontrasepsi pasca persalinan pada kelompok intervensi lebih besar daripada kelompok kontrol dengan perbedaan prosentase 61%. Konseling menggunakan ABPK pada ibu hamil memberikan pengaruh yang signifikan terhadap penggunaan kontrasepsi pasca persalinan (p, Influence of family planning counseling using decision-making tool in pregnant women on postpartum contraception use: randomized controlled trialsPurpose: Analyzed the influence of family planning counseling using the Decision-Making Tool (DMT) on postpartum contraceptive use. Methods: An experimental study with randomized controlled trials design. The study population was pregnant women during their pregnancy at public health center in Yogyakarta. Samples were obtained randomly which meet the inclusion and exclusion criteria. The independent variable was the family planning counseling interventions using DMT. The dependent variable was the postpartum contraceptive use. Bivariable analysis used chi-square test with significance of p-value of

Fertility intention of reproductive age women and unique unintended pregnancy in Indonesia: an analysis of performance monitoring and accountability 2020Purpose: This research aimed to study the connection of fertility intention with unintended pregnancy of reproductive women in Indonesia. Methods: This cross-sectional study used performance monitoring and accountability data 2020 phase I of 2015. Subjects were 5,581 reproductive women of age 15-49, married, sexually active, ever pregnant and fecund. Analysis techniques used univariable (descriptive), bivariable (chi-square), while multilevel (general linear model) was used as last analysis technique for hierarchical data such as performance monitoring and accountability data. All tests used confidence interval (CI) 95% and significance rate p, Latar Belakang: Angka kematian ibu (AKI) di Indonesia mengalami peningkatan dari tahun 2007 sampai dengan tahun 2012. Salah satu penyebab AKI di Indonesia adalah aborsi yang memberikan kontribusi 11-30%. Aborsi merupakan konsekuensi dari kehamilan tidak diinginkan (KTD). KTD di Indonesia tahun 2015 mengalami peningkatan jika dibandingkan dengan angka di tahun 2012. KTD pada tahun 2015 mencapai 16%, sedangkan tahun 2012 mencapai 13,6%. KTD terjadi karena kegagalan alat kontrasepsi, tidak menggunakan alat kontrasepsinya dengan benar dan konsisten atau tidak menggunakan alat kontrasepsi apapun. Faktor lain yang mempengaruhi KTD adalah inkonsistensi intensi fertilitas, dimana terdapat beberapa wanita dengan intensi fertilitas tidak ingin anak lagi mengalami KTD.Tujuan: Mengkaji hubungan intensi fertilitas dengan KTD pada wanita usia subur di Indonesia.Metode: Penelitian dengan rancangan cross sectional menggunakan data PMA 2020 Gelombang I tahun 2015. Subjek penelitian adalah 5.581 wanita usia subur 15-49 tahun, telah menikah, seksual aktif, pernah hamil dan subur. Teknik analisis yang digunakan adalah univariabel (deskriptif), bivariabel (chi-square), multilevel (general linier model) digunakan sebagai teknik analisis akhir untuk data hierarki seperti data PMA. Seluruh tes menggunakan confidence interval (CI) 95% dan tingkat kemaknaan p 0,05.Hasil: Analisis Multilevel menunjukan bahwa WUS dengan intensi fertilitas tidak ingin anak lagi memiliki peluang 1,53 kali lebih besar mengalami KTD dibandingkan dengan WUS yang belum memutuskan intensi fertilitasnya (P

Contraceptive use after childbirth and contraception failure: an analysis of Indonesia Demographic Health Survey 2012PurposeThis research aimed to evaluate the use of contraception after childbirth with contraception failure. MethodsThis research was an observational study using IDHS 2012 with a retrospective cohort design. Married women who got pregnant while using contraceptives were the unit of analysis. Statistical analysis used survival analysis with stratified Cox Regression methods.ResultsAnalysis showed a higher failure rate in the traditional contraceptive methods such as coitus interruptus and periodic abstinence. The failure rate of the contraceptive method implant in Indonesia was higher by 10 times the global failure rate. Women who had used contraceptive for 33-48 weeks and >48 weeks after childbirth had higher risk of pregnancy with contraceptive failure (respectively HR=1.25; 95% CI: 0.63-2.47 and 1.91; 95% CI: 1-3.67), respectively. Other factors influencing the contraceptive failure were age and met or unmet needs.ConclusionContraceptive use after childbirth is associated with contraceptive failure among woman of childbearing age in Indonesia. Providers of contraceptive implants may introduce additional variations of implantable contraceptives in Indonesia and are supported by qualified health personnel., PurposeThe purpose of this study was to examine the effect of spacing use of contraception after childbirth with contraception failure. MethodAn observational study was conducted using IDHS 2012 with retrospective cohort design. Women of childbearing age who never married were currently using contraception as a unit analysis. The group the analyzed by a spacing use contraception after childbirth. ResultsThe study found higher failure in the traditional contraceptive methods such as coitus interruptus and periodic abstinence. The failure rate of the contraceptive method implant in Indonesia has higher than 10 times the global failure rate. Women has use contraceptive 33-48 weeks and >48 weeks after childbirth to higher risk of preganancy with contraceptive failure (respectively HR=1,25; 95%CI=0,63-2,47 dan 1,91; 95%CI=1-3,67). Another factor influencing the failure is aged and met ned or unmet need.ConclusionThis paper contributes to our understanding of the relationship of contraceptive use spacing after childbirth and contraceptive failure with woman of childbearing age in Indonesia. Appropriate education, counseling and appeals for appropriate use of contraceptives need to be improved to raise awareness and awareness of contraceptive use.

Implementation of district level "four children better" family planning policy in MalinauPurposeThis study aimed to analyze the implementation of family planning program policy in Malinau.MethodsA case study was conducted through in-depth interviews with 18 participants.ResultsThe policy of the government in Malinau is ‘four children are better’. Differences in perceptions between stakeholders, providers, and users about family planning affecting social, economic, cultural, beliefs have an impact on contraceptive use in Malinau. The use of contraception is not prohibited for people with medical indications for using contraception, but peo­ple should access the contraception independently in the private sector.ConclusionThe policy of the Ma­linau government to stop the supply of contraceptives to government health facilities since 2012 is an effort by local governments to increase the number of inland and border populations. The unavailability of con­traceptives in government health facilities and the limitations of family planning information, communica­tion and education lead to differences in perceptions between stakeholders, service providers, and users. Therefore, the researcher recommends that the relevant regional apparatus unit does advocacy to legislative and executive boards in Malinau. The local government shall ensure the availability and quality of family planning services for the community on the basis of reproductive health rights., Tujuan: Penelitian ini menganalisis pelaksanaan kebijakan program keluarga berencana di Kabupaten Ma­linau.Metode: Studi kasus melalui wawancara mendalam pada 18 responden.Hasil: Kebijakan pemerintah daerah Malinau adalah empat anak lebih baik. Perbedaan persepsi antara stakeholder, pro­vider dan user mengenai KB dapat mempengaruhi sosial, ekonomi, budaya, keyakinan berdampak ter­hadap penggunaan kon­trasepsi di Malinau. Penggunaan kontrasepsi tidak dilarang bagi masyarakat yang memiliki indikasi medis untuk ber KB, namun masyarakat harus mengakses kontrasepsi secara mandiri di sektor swasta.Implikasi praktis: Pemerintah daerah wajib menjamin ketersediaan dan pelayanan KB yang berkualitas bagi masyarakat atas dasar hak kesehatan reproduksi.Keaslian: Kebijakan pemerintah daerah Malinau dalam menghentikan suplai alokon ke fasilitas kesehatan pemerintah sejak tahun 2012 merupakan upaya pemerintah daerah untuk meningkatkan jumlah penduduk di wilayah pedalaman dan perbatasan. Ketidaktersediaan alat kontrasepsi di fasilitas kesehatan pemerintah dan terbatasnya pemberian KIE KB menimbulkan persepsi yang berbeda antara stakeholder, provider, dan user. SKPD perlu mengadvokasi kepada DPRD Malinau dan Bupati.

Background: It is recommended for a mother to initiate to give early breastfeeding for a newborn as the first breast milk is known to be nutritious and contains antibody. The delay of breastfeeding shows that non breast milk-supplementary food is given. Based on BPS and Macro International data 65% of infants received pre-lacteal feeds besides breast milk in their three days of life.Objective: the known relationship between pre-lacteal feeds and infants’ survival in Indonesia.Method: This was an observational study with a cohort retrospective study design by using IDHS data year 2007. Samples were all infants (0-12 months, breastfed after birth) from mothers aged 15-49 years old as many as 2,886 mothers. The independent variable was pre-lacteal feeds after birth and the dependent variable was infants’ survival. The analyses used univariable, bivariable, and survival analysis with KaplanMeier, Log regression and Cox regression.Result and Discussion: Bivariable analysis using survival Kaplan-Meier showed that there was a significant relationship between pre-lacteal feeds after birth and infants’ survival. The survival of infants who received pre-lacteal feeds was greater than that of infants who did not receive pre-lacteal feeds (92%:89%). Multivariable analysis using Cox regression showed that the survival chance in infants who did not receive pre-lacteal feeds was 0.63 times lower than that in infants who received pre-lacteal feeds (HR 0.63; CI 95%=0.42-0.95).Conclusion: Pre-lacteal feeds showed a significant result with infant survival. Other factors affecting infant’s survival were mother’s age < 20 and ≥ 35 years, low economic status, and birth assistant with non professional.Keywords: infant’s survival, pre-lacteal feeds, infant

Effects of health facility ownership and type of providers on contraception discontinuation: an analysis of 2012 Indonesian demographic health surveyPurposeThis study aimed to examine the role of source of family planning services and types of providers on the discontinuity pattern of modern contraceptive use in women of childbearing age.MethodsThis study analyzed the longitudinal data using secondary data of the IDHS 2012. The sample criteria were: women ever married, aged 15-49, who have ever used modern contraception (pills, injections, IUDs and implants). Stratified Cox models were used to assess the effect of predictors toward contraceptive discontinuation.ResultsKaplan-Meier curves showed higher discontinuity in the short-term contraceptive methods such as injections and pills. Multivariable analysis showed the influence of method source to discontinuation after controlling for other factors, namely age, number of children, education level and place of residence. The risk of discontinuation was greater in government source than private, with HR 1.14 95% CI (1.06 to 1.23). Sub-sample analysis of private services showed a greater chance of discontinuity in physician, with HR 1.28 95% CI (1.06 to 1.54).ConclusionContraceptive discontinuation rate was lower among women using private source and midwives. Women with older age had greater number of children, and the factor of low education levels also was associated with longer duration of contraceptive use., Latar belakang: Tingkat putus pakai kontrasepsi modern yang cukup tinggi mengurangi efektivitasnya dalam mencegah kehamilan tidak direncanakan sehingga berkontribusi pada stagnansi TFR. Kontinuitas penggunaan dapat diperoleh dengan pemberian layanan berkualitas. Peran provider dan sumber pelayanan KB diduga mempengaruhi kontinuitas melalui penyampaian layanan yang berkualitas. Penelitian bertujuan mengkaji peran sumber pelayanan KB dan jenis provider terhadap pola diskontinuitas penggunaan kontrasepsi modern pada WUS. Metode: Peneliti menganalisis data longitudinal menggunakan data sekunder SDKI 2012. Sampel yaitu WUS yang pernah menggunakan kontrasepsi pil, suntik, IUD dan implan. Analisis diskontinuitas berdasarkan prediktornya dilakukan dengan stratified cox model. Hasil: Kurva Kaplan-meier menunjukkan bahwa diskontinuitas lebih tinggi pada metode kontrasepsi jangka pendek seperti suntik dan pil. Analisis multivariabel membuktikan, setelah mengendalikan faktor lain yaitu umur, jumlah anak, tingkat pendidikan dan tempat tinggal, terdapat pengaruh sumber pelayanan KB pada diskontinuitas. Resiko untuk diskontinuitas lebih besar pada sumber pelayanan KB pemerintah HR 1,14 95% CI (1,06 – 1,23). Analisis sub-sampel sumber pelayanan swasta menunjukkan resiko diskontinuitas lebih besar pada jenis provider dokter, HR 1,28 95% CI(1,06 – 1,54).Kesimpulan: Tingkat diskontinuitas penggunaan kontrasepsi modern lebih rendah pada wanita dengan sumber pelayanan swasta dan jenis provider bidan. Tingkat diskontinuitas juga lebih rendah pada wanita berumur lebih tua, jumlah anak lebih banyak, dan tingkat pendidikan rendah.

Background: Two rotavirus vaccines have been availablefor use. The objectives of the study to examine disease burdenof diare rotavirus and the cost and effectiveness of a rotavirusvaccination program in Indonesia.Material and Methods: Data on direct and indirect costs ofchildren with rotavirus diarrhea were established in PurworejoDistrict and Yogyakarta city. It was extrapolated to nationalestimates on the basis of the projected birth cohort in 2007and diarrhea morbiditity rate at national level. The main outcomemeasures were economic burden and cost-effectiveness ratio(Rupiah per DALY averted).Results: The disease burden is equivalent to an economicburden of an estimated Rp390.4 billion in medical direct costs,Rp 67.3 bilion in nonmedical direct costs, and 70.4 billion rupiahin indirect costs. From the health care system and communityperspectives, universal vaccination of infants at a cost of lessthan US $12,7 for a vaccine dose would be a cost-effective ofpublic health intervention.Conclusions and Recommendation: In Indonesia, rotavirusvaccination would reduce the morbidity burden of rotavirusinfection, but would not be cost-effective unless the price ofvaccine decreased considerably. At the current price ofvaccine, universal vaccination program for rotavirus wouldnot be recommended.Keywords: burden of disease, rotavirus diarrhea vaccine,cost-effectiveness

Background: Recent controversial reports suggest that recipients of one dose of DTP vaccines had higher mortality than children who had received no DTP vaccine. We reanalyzed data on vaccination and child survival collected from demographic and health surveillance to challenge previous findings.Objectives: To estimate specific and non-specific effects of DTP vaccination on child mortality age 1-24 months under routine vaccination program in Indonesia.Methods: A longitudinal surveillance data provided information on 5647 children below 24 months of age who received DTP and other vaccinations. The main outcome measure was all-cause mortality. Background factors associated with mortality were collected, such as: sex, birth order, dead sibling, mother’s education and family size. We assessed DTP vaccinations as an independent factor with other variables in Cox’s regression models with time dependent covariates.Results: There is no sex differential of mortality among children in Purworejo even after considering other factors using Cox regression analysis. Mortality was lower in the group vaccinated with DTP vaccine compared with those not vaccinated, the relative risk of mortality (RR) being 0.56 with 95% confidence interval (CI) is 0.453–0.690. After controlling for the background factors, recipient of DPT vaccines continued to have a lower mortality with RR=0.74 (95% CI: 0.586–0.925). BCG and measles vaccines have stronger non-specific effects compared to effects of DTP vaccines.Conclusion: Through specific effect against targeted diseases and a non-specific benefit against others illnesses, the study showed reduced mortality among children who received DTP vaccine. There is no reason to change current vaccination policy because DTP was not associated with any harmful effect among girls.Keywords: non-specific effects, DTP Vaccine, child survival, Cox’s Regression