Journal of Health Technology Assessment in Midwifery ISSN 2620-8423 (print) | 2620-5653 (online)

Vol. 3, No. 2, November 2020, pp. 87-93 87

Husband’s support on the use of intrauterine device (IUD) and

implant contraceptives among Indonesian couples
Retno Heru Setyorinia,1,*, Era Revikab,2, Riadini Wahyu Utamib,3, Oktriyantob,4, Mardiana Dwi b,5
b
AKBIDYO Health Science Institute of Yogyakarta, Indonesia
e
Badan Kependudukan dan Keluarga Berencana Nasional (BKKBN), Indonesia
1
retnoheruhs@gmail.com*
* corresponding author

ARTICLE INFO ABSTRACT

The involvement of men in family planning has an important role in

Article history making decisions related to the use of contraception.
Received, 13-th June 2020 Objectives: This study aimed to determine the effect of husband’s
Revised, 13-th July 2020 support on the use of IUDs and Implant contraception among
Accepted, 1-st September 2020 Indonesian couples.
This is an analytic survey with a cross-sectional approach. The sample
was selected by using the Slovin formula, resulted 398 respondents.
Keywords Sampling was carried out using accidental sampling. Data collection
Husband’s support was carried out using a questionnaire. Validity and reliability tests were
IUD carried out using Pearson's product-moment and Cronbach's alpha.
Implant Results analysis of the study was carried out by multiple logistic
regression.
251 (63.1%) husbands were supporting the use of IUDs and Implant
contraception as much as 147 (36.9%) others did not support the use of
both contraceptives. The results of multiple logistic regression analysis
are OR = 7,713; p = 0,0001. Husband's support influences the use of
IUDs and Implant contraception.

This is an open access article under the CC–BY-SA license.

1. Introduction
Nationally, family planning programs in Indonesia are more directed at the use of long-term
contraceptive methods (IUDs, Implants, tubectomy, and vasectomies) rather than the short-term ones
(injections, pills, and condoms) (BKKBN 2015). Although long-term contraceptives such as the IUD
and Implant are effective in preventing pregnancy and are reversible, women are prefer to select
injection methods to IUDs (Bintoro et al. 2019). Globally, about 9% of women of childbearing age
worldwide use oral contraceptives and up to 18% in developed countries (Bawah et al. 2019)
Peipert et al (2011) stated that IUDs and implants are proven to be safe, effective, estrogen-free
so that they can be used earlier in the postpartum period (Center of Disease Control, 2010), no patient
compliance, no repeated visits, and no post-installation additional costs. Long-term contraceptive
methods also reduce the risk of recurrent pregnancy and abortion (Trussell et al., 2009); are more
effective in preventing unwanted pregnancies than pills, patches, or contraceptive rings; and are
effective in all ages (Winner et al., 2012). According to Vinogradova, Coupland, & Hippisley-cox
(2015), oral contraceptive pills are known to be associated with an increased risk of thromboembolism.
Social demographic factors, communication about family planning, and fertility preferences
play an important role in contraceptive use (Apanga & Adam, 2015). Husbands' consent determines
the use of contraceptives. Research (Frost & Lindberg, 2013) showed that 30% of women answered
that the use of contraception was based on the wishes of their husbands.

10.31101/jhtam.1399 https://ejournal.unisayogya.ac.id/ejournal/index.php/JHTAM
jhtam@unisayogya.ac.id
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Vol. 3, No. 2, November 202020, pp.87-93

Discussion, dialogue between husband and wife, and husband's agreement (partner) help
alleviate fear and misinformation and increase the use of modern contraception (Yue, O'Donnell, &
Sparks, 2010). This study aims to determine the effect of husband support on the use of IUDs and
Implant contraceptives.

2. Methodology
This is an analytical survey research with a cross-sectional approach (Bruce, Pope, and
Stanistreet 2008). conducted in August-November 2018. The population in this study was 102,254
respondents in Sleman Regency using contraception IUDs, implants, pills, injections, and condoms.
The sample calculation using the Slovin formula yielded 398 respondents. Sampling was carried out
using accidental sampling. Data collection was carried out using a questionnaire. The validity and
reliability of the questionnaire tests were carried out using Pearson's product-moment and Cronbach's
alpha. Analysis of the results of the study was carried out by multiple logistic regressions.

3. Result

3.1. Distribution of Respondent Characteristics, Level of Knowledge, Husband's Support,

and Use of Contraception
The frequency distribution of respondents' characteristics, level of knowledge, husband's
support and the use of contraception can be seen in Table 1 below:

Table 1. Distribution of Respondent Characteristics, Level of Knowledge, Husband's Support, and Use of
Contraception
No. Variable N %
1 Age
< 20 Years old 3 0,8
20-30 Years old 83 20,9
>30 Years old 312 78,4
2 Educational level
Elementary-Secondary School 84 21,1
High School 265 66,6
College 49 12,3
3 Level of knowledge
Low 152 38,2
Moderate 225 56,5
Good 21 5,3
4 Husbands’ supports
Not support 147 36,9
Support 251 63,1
5 IUD implant users 244 61,3
Non IUD and implant users 154 38,7
Source: 2018 Primary Data

Table 1 shows that 78.4% of respondents were over 30 years old, 66.6% were high school
graduates, 51.6% had sufficient knowledge about contraception and family planning, 63.1% of
husbands supported the use of an IUD and implants, and 61.3 % use IUDs and implants.

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3.2. Correlation of age and use of IUDs and implants.

The correlation between age and use of the IUD and implants can be seen in Table 2 below:

Table 2. Bivariate Analysis with Chi Square Test Between Age and Use of IUDs and Implants
The use of IUD and Implants
Total
Age Not IUD and implant IUD and implant P
N % N % N %
<20 years old 1 0,251 2 0,50 3 0,75 0,590
20-30 years old 52 13,06 31 7,78 83 20,85
>30 years old 191 47,98 121 30,40 312 78,39
Total 244 61,31 154 38,69 398 100
Source: 2018 primary data
Table 2 shows that age does not affect/relate to the use of IUDs and implants with p-value =
0.590

3.3. The correlation between educational level and the use of IUDs and implants
The correlation between educational level and the use of IUDs and implants can be seen in
Table 3 below:

Table 3. Bivariate Analysis Using the Chi Square Test on the Correlation Between the Level of Education
with the Use of IUD, Implants
The use of IUD and Implants
Total
Educational level Not IUD and Implant IUD and Implant P
N % N % N %
Elementary school 54 13,57 30 7,54 84 21,11 0,713
High School 162 40,70 103 25,87 265 66,58
College 28 7,04 21 5,27 49 12,31
Total 244 61,30 154 38,69 398 100
Source: 2018 primary data
Table 3 shows that there is no correlation between the educational level with the use of IUDs
and implants with ρ-value = 0.713

3.4. The correlation between Knowledge with The use of IUD and Implants
The correlation between the level of knowledge with the use of IUDs and Implants can be seen
in table 4 below:

Table 4. Bivariate Analysis Using the Chi Square Test on the Correlation Between the Level of Knowledge
with the Use of IUD, Implants
The use of IUD and Implants
Total
Knowledge level Not IUD and Implant IUD and Implant P
N % N % N %
Low 98 24,62 54 13,57 152 38,19 0,581
Moderate 134 33,67 91 22,86 225 56,53
Good 12 3,01 9 2,26 21 5,28
Total 244 61,30 154 38,69 398 100
Source: 2018 primary data
Table 4 shows that there is no correlation between the level of knowledge with the use of IUDs
and Implants with p-value = 0.581

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3.5. The Correlation between Husband’s Support With The use of IUD and Implants
The correlation between husband’s support with the use of IUD and Implants can be seen in
table 5 below:

Table 5. Bivariate Analysis Using the Chi Square Test on The Correlation Between the Husband’s Support
with The Use of IUD, Implants
The use of IUD and Implants
Husband’s Total
Not IUD and Implant IUD and Implant OR P
support
N % N % N %
Not support 130 32,66 17 4,27 147 36,93 9,190 <0,0001
Support 114 36,18 137 34,42 251 63,06
Total 244 61,31 154 38,69 154 38,69
Source: 2018 primary data
Table 5 shows that there is a statistically significant correlation between the husband’s support
and the use of IUDs and implants with p-value = 0.0001

3.6. Multivariate Logistic Regression Test Results For Each Variable

Multivariate logistic regression tests on each variable showed that age, education level, and
knowledge level did not affect the use of IUDs and Implants, while husband's support influenced the
use of IUDs and Implants (table 6)

Table 6. Multivariate Analysis of Factors Affecting the Use of IUDs and Implants with Multiple Logistic
Regression Tests
Exp (b) CI 95%
Independent variable P
OR Lower limit Upper limit
Knowledge 1,236 0,821 1,860 0,310
Education (College) 1,038 0,686 1,568 0,861
Age (> 30 years old) 0,742 0,417 1,321 0,310
Attitude (positive) 2,376 1,456 3,879 0,001
Husband’s support (support) 7,713 4,299 13,838 0,0001
Source: 2018 Primary Data
Those with higher education were 1.038 more likely to use an IUD and implants than those
with lower levels of education (OR = 1.038; CI 0.688-1.568; p = 0.861). Those over the age of 30
years were more likely to use an IUD and implants 0.742 times more than those less than 30 years
(OR = 0.742; 95% CI 0.417-1.332; p = 0.310). The use of IUDs and implants by mothers of more-
than-3 children is 0.559 times greater than those with 1 or two children (OR = 0.559; CI 0.369-0.849;
p = 0.006). Sami support for the use of IUDs and implants can improve the use of contraception by
7,713 (OR = 7,713; 95% CI 4,299-13,838; p = 0.0001).

4. Discussion
The results showed that most of the childbearing age couples aged 30 years and over. In
addition, the analysis also shows that age does not affect the use of IUDs and implants by women of
childbearing age. This is in line with research which reported that statistically, age does not influence
behavior but rather social influence (Radulovi et al. 2016). In addition, social influences can influence
the healthy behavior of individuals, families, friends, and the work environment (Bintoro et al. 2019).
The educational level of most respondents in this study was high school, in that it did not affect
the use of IUDs and implants. Pinontoan (2014) stated that the level of education did not affect the
use of an IUD. The high level of education of a person does not necessarily underlie the use of IUD
or implant contraception. Users have other reasons underlying their use of contraception. One of the
reasons is comfort and compatibility with previous contraception (Ahmed et al. 2019).
Knowledge of family planning and contraception determines the process of one's acceptance of
the use of contraception. Besides, it also determines important steps towards access and use of
appropriate and effective contraception. In fact evidence stated that the lack of knowledge about
family planning inhibits the use of contraception (Sundararajan et al. 2019). But the results of this

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Vol. 3, No. 2, November 2020, pp. 87-93

study did not show the effect of knowledge on the use of an IUD or implant. This is in line with a
research conducted in different context which showed that contraceptive knowledge possessed by
students does not increase its use (Mbugua and Karonjo 2018). The use of IUDs and Implant
contraception is influenced by knowledge, social norms (Dynes, Stephenson, Rubardt, & Bartel,
2012), the role of the counselor (Robby et al, 2019), and service limitations (Babalola, Figueroa, and
Krenn 2017).
The results showed that the husband's support influenced the use of IUDs and implants. This
finding meet with another study which stated that there is a significant relationship between the
husband's opinion regarding implants on the use of contraception (Baschieri et al. 2013). Green (1980)
stated that behavior is determined by three factors, namely predisposing factors, supporting factors,
and driving factors. Support is included in the driving factors that determine a woman's behavior in
the use of implants; the greater the role of the husband in the use of implants, the higher the level of
use.
Husbands/partners are important figures in the sexual and reproductive lives of women and
contribute to the culture in which women live. The husband is one of the closest people to women of
childbearing age where his support influences the choice of contraception. The involvement of men
in family planning can deal with misperceptions, myths, gender attitudes, and health problems. More
than that, men play an important role in making decisions related to contraceptive use. A study
revealed that the husband's opinion influences the determination of contraceptive use by the wife
(Sundararajan et al. 2019). It means that men's involvement in family planning programs can improve
some contraceptive practices in the future (Tilahun, Coene, Temmerman, & Degomme, 2014)
Social demographic factors, partner communication about family planning, and fertility
preferences play an important role in contraceptive use. Apanga & Adam (2015) prove that the high
awareness of family planning services is not always directly proportional to the acceptance of the
service. This happens when community members do not get good information about the benefits of
family planning. Educational campaigns about the benefits of family planning services can reduce
misunderstandings and improve access and utilization of these services.
Husband and wife discussion and the role of the husband in encouraging such dialogue can help
minimize fear and misinformation thereby increasing the use of modern contraception (Yue,
O'Donnell, & Sparks, 2010). Improved couple communication can help women identify their
husband/partner's consent (Prata et al., 2015). On the other hand, poor communication tends to trigger
uncertainty or indifference, as reported by many women regarding approval or encouragement about
the ideal family. It means that men must also be educated about the benefits of family planning
services to increase their agreement and support for the use of contraception.

5. Conclusion
Husband's support influences the use of IUDs and Implant contraception. Communication
between husband and wife plays an important role in the use of contraception where each husband
and wife should have a dialogue about the contraception to be used.

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