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Contraceptive Discontinuation in Bali, Indonesia

Evi Nurvidya Arifin

Family planning program through promoting the use of contraceptive use have played an important role in reducing fertility in many countries. In the early stage of an implementation of the program, its focus is to motivate couples to adopt contraceptive use. Therefore, contraceptive prevalence has been used as an indicator to evaluate the implementation of family planning program. However, as contraceptive use increases and becomes strongly established in societies, it is recognized that its success cannot be adequately measured by an increase in the contraceptive prevalence. The focus should be shifted to encourage couples to maintain the use (Kost, 1993). The use can be maintained by giving couples counseling when problems appear and providing them with a range of contraceptive options to suit their needs (Curtis and Hammerslough, 1995; Curtis and Blanc, 1997).

In other words, the focus on quality of care has become more important than simply on contraceptive prevalence, with contraceptive continuation as one of the outcomes of the quality of care (Blanc, Curtis, and Croft, 1999). Therefore, studies on contraceptive discontinuation have become increasingly more relevant.

Bali is selected because of both substantial and practical reasons. On the substantial grounds, Bali has achieved below replacement level since the beginning of the 1990’s with contraceptive prevalence rates more than 70%, and hence attention should have focused more on quality care (including contraceptive continuation). Furthermore, Indonesia is a very heterogeneous society and attention to a particular region within Indonesia has become a more relevant approach to study Indonesia. In particular, the government of Indonesia has been implementing regional autonomy since 2001.

As in other event history analyses, the length of time before the occurrence of an event is very important as in Curtis and Blanc’s study. Because Indonesia is a very large country, the approach of using one month as the segment has resulted in the explosion of the number of observations. Therefore, for a practical reason, the analysis is then limited to Bali, so that the data set becomes manageable.

This paper uses contraceptive calendar data collected in the 1991 and 1994 Indonesia Demographic and Health Surveys.

The cumulative probability of discontinuation at the first 12 months of the initiation of use in 1986-1991 was 19.3%, increased to 24.9% in 1989-94. Side effects and health concerns are the most common reasons to discontinue. With a multilevel discrete-time competing risks hazard model, the study found that contraceptive method chosen and duration of use are strongly associated with contraceptive discontinuation. Socio-economic and demographic factors are also important in this matter. Unobserved heterogeinity at woman level significantly affects contraceptive discontinuation.

This is an extended abstract of the paper entitled “Factor Associated with Contraceptive Discontinuation in Bali, Indonesia: A Multi-level Discrete-time Competing Risks Hazard Model”, Asian MetaCentre Research Paper Series no.15.

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