The Primary Health Center Factors Associated with Contraceptive Use Among Women in Indonesia

Access to health care, especially health care’s days open was one of the important poin to increasing contraceptive user. Many people who want to use contraception tend to want to get the method in the same day when visited the health care. The aim of this study is to find the relationship health care days open and contraceptive utilization. The cross-sectional study used Performance Monitoring and Accountability (PMA) 2020 data in 33 provinces of Indonesia in 2015. The research subjects were primary health care (Puskesmas). In this research, a number of districts were merged to reach a minimum number of respondents of 30 women. One hundred and four health center were studied and analyzed with t-test and correlation, and multivariable analysis by looking at the level of significance p <0.05, and multivariable analysis. Female, household, and service delivery point questionnaire were used in this study. Result: All health centers in 76% area in Indonesia open more than five days a week and no stock out more than five contraceptive methods. All health centers in 69% area provides more than 5 methods. Days open statistically significant ISSN 2354-7642 (Print), ISSN 2503-1856 (Online) Jurnal Ners dan Kebidanan Indonesia Tersedia online pada: http://ejournal.almaata.ac.id/index.php/JNKI INDONESIAN JOURNAL OF NURSING AND MIDWIFERY


INTRODUCTION
The international conference on population and development (ICPD) committed to universal access coverage on reproductive health. More than last 20 years many countries have reached big progress in increase access to reproductive health care, efforts to decrease fertility rate, decrease mortality rate, and increase people's education and economic.

Family planning or Keluarga berencana (KB)
is means of controlling birth rates, but also serves to preventing maternal and infant morbidity, and empower woman to raise their economics status and provide choice. That appropriate method what women want it, one of the efforts to increase healthy and prosperity of woman, then also to decrease poverty (1)(2)(3)(4). The indicator that we can use to evaluate successfully from a program is how the goal that we got it in society (5).  Primary health centers are the closest place for women to obtain contraceptives. A good program and optimal access can influence contraceptive use in the community. Optimal access could be interpreted as providing the right services at the right time and the right place (9). Someone inclined to want health care on the same day as desired. When health facilities are unable to provide services on the same day, may be due to operating hours or other reasons, it causes a person's willingness to come back at another time (10). The length of waiting time can be associated with the internal system of health facilities, availability of skilled personnel, facilities, or opening hours. Because it has not many studies that review the duration of health services, so the researcher wanted to examine frequency of contraceptive service days and see the correlation with the utilization of family planning in Indonesia.

MATERIALS AND METHODS
The research method in this study is quantitative research with cross sectional study design used data Performance Monitoring and Accountability (PMA) 2020 in Indonesia in 2015.
Project PMA 2020 is a survey which aims giving back to surveillance and evaluation system on a global scale by providing information in order reporting, planning, operational decision making and advocacy at the district or city, provincial, national, and global.  Every single variable had a normal distribution data. More than half of women in  Table 4 illustrates that more than two-thirds of the region of research already have health centers are provide family planning services entirely over 5 days a week. In addition, most of the study area did not experience any stock outs. Health Center which provides more than 5 planning methods as much as two-thirds than total health centers were interviewed. Health Center respondents evenly spread in the Java-Bali and outside Java-Bali.

Frequency contraceptive day services
statistically not significant with contraceptive utilization, but practices related with contraceptive utilization. When all health centers provide than five methods will increase 5% contraceptive utilization.    In addition, health workers serving in health facilities are given the opportunity to conduct private practice outside the working hours of health facilities (12). This situation illustrates that people in Indonesia are given many facilities to fulfill their rights to obtain health services.
One of the points to measure access was its utility. But not always increasing access in an area means good. When the availability of services was improved, this will increase the number of services in a region. The impact is that visits to each service will decrease from before.
So that there will be no increase in utilization Stock out is one of the factors that influence a person's use of contraception. In this study it was found that practically, the availability of contraceptive methods in PUSKESMAS was able to influence the use of contraception in women reproductive age. When in all health service in the region there was no stock out of the contraceptive method, it was able to increase the prevalence of contraceptive use by 9.5%. The availability of methods is one of the determinants of satisfaction and continuity of contraceptive use in a person (13,14). This stock out relates to a person's limitations in choosing what they want.
When someone wants a modern family planning method, but health facilities are not able to serve because their supplies run out, it causes many people didn't want to choose other methods and discontinuity occurs.
The method provided by the health facility was not statistically related to the use of family planning, but in practice when all health facilities in the region are able to provide more than 5 methods an increase in the proportion of family planning users by 5% will occur. The more contraceptive methods offered by a health facility, the more contraceptive use rates will increase in the community. When associated with stock out, it is known that 65% of PUSKESMAS that provide more than the contraceptive method do not have a history of stock outs. It can see that the availability of methods in Indonesia is quite good.
Women's economic was not statistically related to the use of contraception. There was a negative correlation between these two factors, The consideration for making decisions will be more rational.
This research found a negative relationship between education and the use of modern contraception. These findings can be interpreted that when an area increases in the proportion of highly educated population, the proportion of contraceptive use is actually low. As Nasution argues (19), someone with higher education tends to be more rational. But it could be with minimal information or a more dominant personal perception, causing them to agree more with the opinion that there will be no problem even if they do not use family planning. Because they believe that they can overcome various problems that will arise in the future (20).  users. So that all health facilities both private and government-owned should be able to provide services more than 5 days a week, no methods are exhausted, and at least provide more than 5 methods of contraception.