Skip to main content
Download PDF

Barriers for multiparous women to using long-term contraceptive methods in Southeast Asia: case study in Philippines and Indonesia

BMC Public Health volume 22, Article number: 1425 (2022) Cite this article

Abstract

Background

Multiparous women are supposed to be able to end their reproductive cycle to decrease population growth. This study aimed to analyze barriers for multiparous women to use long-term contraceptive methods (LTCM) in the Philippines and Indonesia.

Methods

The study population was women aged 15–49 years old who have given birth to a live baby > 1 in the Philippines and Indonesia. The weighted sample size was 12,085 Philippines women and 25,543 Indonesian women. To identify variables associated with the use of LTCM, we analyzed place of residence, age group, education level, marital status, employment status, and wealth status. The final step employed multinomial logistic regression.

Results

In both countries, the results showed that variables associated with non-user LTCM were younger women, living in rural areas with poor education. Women without partner and unemployed had higher probability to not use LTCM. Finally, low wealth status had a higher probability than the richest multiparous to not use LTCM.

Conclusion

The study concluded that there were six barriers for multiparous women to use LTCM in the Philippines and Indonesia. The six obstacles were living in rural areas, being younger, poor education, single, unemployed, and low wealth.

Peer Review reports

Introduction

Population growth in Southeast Asia has outpaced growth in the U.S., U.K., and China in the last 5 years. Meanwhile, the population growth rate in Southeast Asia is 5.8%. Philippines population growth of 8.2% is the highest growth compared to other Southeast Asian countries. Indonesia’s population grows by 5.9%, just below Malaysia’s at 7.9% [1].

Southeast Asia’s current population is 672,082,017, equivalent to 8.58% of the world’s total population. Southeast Asia is ranked number 3 in the Asian region. The population density in Southeast Asia is 154 per km2, and 50% reside in urban areas. The mean age of the Southeast Asian population was 30.2 years. Based on population, Indonesia is ranked first in the Southeast Asia region and fourth globally, with 273,523,615 people. The Philippines is in second place in the Southeast Asia region and 13 globally, with 109,581,078 people. The rapid population growth in Indonesia and the Philippines indicates that the number of pregnancies that reach proper delivery in both countries is high [2, 3].

The number of pregnancies that achieve a viable delivery referred to as parity [4]. Women who have given birth more than two times are called multiparous and have given birth ≥ four times called grand multiparous. The more often a woman gives birth, the more it has the potential to increase population growth. The crude birth rates in the Philippines and Indonesia are ranked 4th and 5th in the Southeast Asia region, namely 20.2 and 17.7 live births per 1000 population [5]. The family size in the Philippines also allows a woman to give birth more than two times. The Philippines’ average ideal family size is 2.7 children for all women and 3.0 children for currently married women [6].

The high proportions of multiparous and grand multiparous cause population growth to occur rapidly. The distribution of currently married women in Indonesia is 25.57% multiparous and 4.27% grand multiparous. The remaining 62.58% were primiparous, and 7.57% never gave birth based on parity [7]. In some countries, the proportion of multiparous shows a higher number than primiparous. Among them are Nigeria, Uganda, Northwestern Ethiopia, and North Carolina [8,9,10,11]. This situation is different when we compare it to China. The proportion of multiparous women is 15.5%, primiparous 29.1, and 55.4% childless [12].

The utilization of LTCM is related to many factors, several studies showed that facts [13,14,15]. One of the factors is related to pregnancy, both planned and unplanned pregnancies. For example study conducted by Pasundani in 2020 [15] in Indonesia, age, education, parity, and information are all variables that have been linked to the usage of LTCM. Other study revealed the same messages that unplanned pregnancy was also factors for women utilize the LTCM [16].

Meanwhile, women who give birth more than two times have the risk of various complications of pregnancy and childbirth and even death. The risk of death from maternal causes is related to pregnancy risk and complications during birth [17]. The three causes of maternal death in the Philippines include complications of delivery, pregnancy-related hypertension, and postpartum hemorrhage [18]. Multiparous women have less time to recover their reproductive organs and less time to rest. Multiparous has an increasing burden as the number of children born. In general, the history of miscarriage and gestational diabetes was higher in the grand multiparous [19].

Previous studies found a significant association between grand multiparous and pregnancy outcome. Among them include cesarean section, fetal macrosomia, diabetes mellitus, hypertension in pregnancy caused [20]. Multiparity is still a threat to women’s health problems. This threat is mainly related to the various complications that can occur during pregnancy and childbirth. Efforts to minimize this threat are to carry out pregnancy and birth control.

Long-term contraceptive methods (LTCM) are the most effective method for controlling pregnancy and birth [21]. Including the LTCM are an intrauterine device (IUD), female sterilization, and implant/Norplant. LTCM can prevent unwanted pregnancy up to 20 times better than pills and vaginal rings [22]. LTCM is a form of birth control that is very effective and has the lowest maintenance costs (most economical) [9, 23]. Unfortunately, women attracted to LTCM but did not use it are more likely to be multiparous women [11]. Although LTCM is proven to reduce pregnancy effectively and is effective regardless of user compliance, its absorption is still low [24, 25].

A previous study in seven countries found that the widespread use of LTCM was still low, namely 16% [26]. IUDs and implants’ use is still low, 1.8 and 10.4%, respectively [9]. Policymakers need to know more information about the various challenges in women’s access to use LTCM. Moreover, we need to investigate this further. This study analyzes the obstacles for multiparous women to use LTCM in the Philippines and Indonesia based on the background description.

Materials and methods

Availability of data and materials

The author is unable to share the data publicly because a third party and the ICF, who own it, do not have permit to do so. The author requested The 2017 IDHS and 2017 PDHS data set to the ICF (data set of childbearing age women) and the ICF gave the access to confidential data through https://dhsprogram.com.

Data source

The report used secondary data as research materials from the 2017 Philippines Demographic and Health Survey (PDHS) and 2017 Indonesian Demographic and Health Survey (IDHS). The PDHS and IDHS are part of the Inner City Fund’s (ICF) Global Demographic and Health Survey (DHS) survey collection. The sample population was women aged 15–49 years who had given birth in Indonesia to a live baby of over 1 (multiparous). The sampling procedure used stratification and multi-stage random sampling. The method yielded a weighted sample size of 12,085 Filipino women and 25,543 Indonesian women. The study period was from July 24th – September 30th 2017.

Data analysis

The dependent variable in this study was the use of long-term contraceptive methods (LTCM). In this study, LTCM is a modern contraceptive type consisting of IUD, female sterilization, and implant/Norplant. The study divides the use of LTCM into 2 categories, namely “Yes” and “No.”

There were six independent variables involved in the analysis of this study. The six variables are a type of place of residence, age group, education level, marital status, employment status, and wealth status. The residence type consists of 2 categories, namely “urban” and “rural.” The urban-rural criteria refer to Statistics Indonesia. Age group is divided into 7 categories in 5 years, namely “15–19”, “20–24”, “25–29”, “30–34”, “35–39”, and “40–45”. Education level is the respondent’s recognition of the last diploma they have. Education level is divided into 4 categories, namely “no education”, “primary”, “secondary”, and “higher”. The study also divided marital status into two categories: “single” and “married/living with a partner.” The study divided into two categories for employment status, namely “unemployed” and “employed.”

The study determined wealth status based on the quintile of wealth owned by a household. Households were scored based on the number and type of items they have, from televisions to bicycles or cars, and housing characteristics, such as drinking water sources, toilet facilities, and primary building materials for the house’s floor. This score calculated using principal component analysis. National wealth quintiles were arranged based on household scores for each person in the household and then divided by the distribution into the same five categories, accounting for 20% of the population [27].

In the first step, the authors conducted a collinearity test. The action is to ensure no multicollinearity between the independent variables. Furthermore, the study carried out a bivariate test between the dependent and independent variables using the Chi-Square test. The study used the binary logistic regression to analyze barriers for multiparous women to use LTCM in Indonesia and Philippines in the final stage, and we used the significancy p < 0.05. We used 95% confidence interval in the binary logistic regression. All stage statistical analyzes carried out using SPSS 22 software.

Ethical statement

The 2017 PDHS and the 2017 IDHS have received ethics approval from the national ethics commission at the Ministry of Health, Philippines, and Indonesia. The authors deleted the respondents’ identities from the dataset. Besides, respondents have provided written approval for their involvement in the study. The author has obtained permission to use Inner City Fund International’s data through its website: https://dhsprogram.com/data/new-user-registration.cfm.

Results

Table 1 showed the results of the co-linearity test. The analysis results displayed the tolerance value for all independent variables was > 0.10, and the variance inflation factor (VIF) value for all independent variables was < 10.00. The results of this analysis informed that there were no symptoms of multicollinearity between the independent variables.

Table 1 The result of multicollinearity test
Full size table

Descriptive analysis

Table 2 showed descriptive statistics of multiparous women in the Philippines and Indonesia. Based on the type of place of residence, Philippines multiparous women who live in rural areas dominated the two categories of the use of LTCM. Meanwhile, multiparous Indonesian women who use LTCM were dominated by those who live in urban areas. Meanwhile, multiparous Indonesian women who do not use LTCM were dominated by those who live in rural areas.

Table 2 Descriptive statistics of multiparous women in Philippines (n = 12,085) and Indonesia (n = 25,543)
Full size table

Based on the age group, women in the 40–44 age group occupied the multiparous Philippines and Indonesian women who use LTCM. On the other hand, the Philippines and multiparous Indonesian women who do not use LTCM are dominated by the younger age group, namely 35–39. According to the education level, the Philippines and multiparous Indonesian women with secondary education dominated the two categories of the use of LTCM.

Based on marital status, the Philippines and multiparous Indonesian women who are married/living with partners dominated the two categories of the use of LTCM. Meanwhile, based on employment status in both types, the use of LTCM is dominated by the Philippines and Indonesian employed women.

Finally, according to wealth status, multiparous Philippines women who use LTCM are dominated by the wealthy class with the lower category. On the other side, multiparous Philippines women who do not use LTCM are dominated by those with the most deficient wealth status category. Moreover, the wealthiest overwhelmed multiparous Indonesian women who use LTCM. On the other hand, the more decadent wealthy status category dominated multiparous Indonesian women who do not use LTCM.

Multivariate analysis

Table 3 showed binary logistic regression results. In this final stage, the study involved all independent variables. The binary logistic regression uses “The use of LTCM: Yes” as references.

Table 3 The result of binary logistic regression of barriers for multiparous women to using LTCM in Philippines (n = 12,085) and Indonesia (n = 25,543)
Full size table

Table 3 showed that multiparous Philippines women living in rural areas are more likely to live in urban areas 1.070 times not to use LTCM (AOR 1.070; 95% CI 1.070–1.070). Meanwhile, multiparous Indonesian women living in rural areas were 1061 times more likely than those residing in urban areas not to use LTCM (AOR 1.061; 95% CI 1.061–1.062). This analysis indicates that living in rural areas is a risk factor for multiparous women in the Philippines and Indonesia for not using LTCM.

According to the age group, Philippines multiparous women in the age group 35–39 and under have a higher likelihood of not using LTCM than the 45–49 age group. Philippines multiparous women in the 40–44 age group are less likely to use LTCM than the 45–49 age group. Meanwhile, multiparous Indonesian women with the age group 30–34 and under have a higher likelihood of not using LTCM than the 45–49 age group. Multiparous Indonesian women in the age group over 35–39 and above are less likely to use LTCM. This information shows that younger multiparous women in the Philippines and Indonesia have a higher risk of not using LTCM.

Based on the education level, multiparous Philippines women with no education have a higher chance of not using LTCM than those with higher education. Multiparous Philippines women with primary and secondary education have a lower possibility of not using LTCM than those with higher education. On the other hand, multiparous Indonesian women with any education level have a higher probability of not using LTCM than those with higher education. This analysis indicates that inadequate education is a risk factor for multiparous women in the Philippines and Indonesia for not using LTCM.

According to marital status, the Philippines and multiparous Indonesian women with a single group (never in a union, widowed, divorced) have a higher probability than those with status married/living with partners not to use LTCM. The result shows that not having a partner is a risk factor for multiparous women in the Philippines and Indonesia for not using LTCM.

On the other side, unemployed multiparous women in the Philippines and Indonesia have a higher probability of not using LTCM than those employed. This analysis shows that the unemployed are a risk factor for multiparous women in the Philippines and Indonesia for not using LTCM.

Finally, based on wealth status, the poorest Philippines multiparous women have a higher likelihood of not using LTCM than the richest one. Multiparous Philippines women with other wealthy groups were less likely not to use LTCM than the richest. On the other hand, multiparous Indonesian women with any wealthy status have a higher chance of not using LARC than the richest. This analysis indicated that low wealth status has a higher probability than the richest multiparous in the Philippines and Indonesia not to use LTCM.

Discussion

The study results found that living in rural areas was a risk factor for multiparous women in the Philippines and Indonesia for not using LTCM. Empirically, rural areas are often left behind compared to urban areas in development in all fields, including the health sector [28]. This situation impacts the availability of information and services to access LTCM for multiparous women [29, 30].

The study found that younger multiparous women in the Philippines and Indonesia had a higher risk of not using LTCM. This finding is in line with studies in India [31]. This condition is likely because older multiparous women tend to want to stop their reproductive period. Meanwhile, those who are young still have the desire to have more children [32, 33].

The research found low education to be a risk factor for multiparous women in the Philippines and Indonesia for not using LTCM. Women with better education levels better understand their needs. Moreover, with better education, women also better understand the risk factors for any action or decision they take [34, 35], including better understanding the myths circulating about LTCM [36]. This reason is why multiparous women with higher education prefer to use LTCM [37,38,39]. Higher education levels have been found in several previous studies to positively determine health performance [38]. Conversely, several studies found poor education to be a barrier to higher-quality implementation in the health sector [40,41,42].

On the other hand, not having a partner was a risk factor for multiparous women in the Philippines and Indonesia for not using LTCM. In the context of countries with Eastern customs such as the Philippines and Indonesia, sexual activity for women who do not have a partner is a disgrace [43, 44]. This condition encourages women to control their sexual activity. This situation is likely to suppress the need for LTCM in unmarried multiparous women.

Meanwhile, the unemployed was a risk factor for multiparous women in the Philippines and Indonesia for not using LTCM. This situation may be due to employed multiparous women who prefer practical and effective contraceptive methods [45, 46]. Previous studies have shown the higher effectiveness of LTCM than non-LTCM methods [47]. On the other hand, LTCM is more effective for employed multiparous women than the forgetfulness factor caused by being busy. Other study revealed that women empowerment factors, one of it is employment, related to the utilization of LTCM [13].

Finally, the study found low wealth status to have a higher probability than the richest multiparous in Indonesia not to use LTCM. The previous studies saw poverty as a barrier to performance output in many health sectors, especially those related to and requiring costs [27, 48]. This situation also applies to poor multiparous women’s access to LTCM [49, 50]. This cost is a barrier that should encourage the government to realize the financing mechanism through insurance for LTCM [38, 51, 52].

In summary, this research shows that six variables prevent a multiparous woman from using LTCM, namely: living in the rural area, younger age, poor education, single, unemployed and poor. The implication of this situation for a country is an uncontrolled population explosion, leading to repeated unfavorable conditions in society, including poverty, ignorance, and high unemployment [53]. Another negative situation is the risk of an unqualified future generation because their parents cannot optimally carry out child care [54].

Previous research has recommended strategies to increase the use of LTCM, including reducing costs to get LTCM services, increasing public understanding of LTCM [55], and increase the skill capacity of health workers [56]. We can develop a strategy by cooperating with relevant stakeholders to make the LTCM program a success in an area [57]. From the findings above, appropriate policy recommendations include: providing subsidies for LTCM services for the poor, initiating an insurance model for LTCM, educating the public massively, being innovative, creative, and measurable, and periodically updating the skills capacity of health workers.

Study limitation

This study has a limitation: the study’s variable is limited and depends on the availability of secondary data (DHS data). However, the study has a positive impact on the maternal and child health programs in Indonesia, such as this study can be estimated to the national level with correct weight to describe the level of the problem at the national level. Furthermore this study can be used by the government to develop policy based on the scientific evidence, especially related to LCTM and how the strategy of the government to deliver it to the specific population in the country.

Conclusions

The research results concluded that there were six barriers for multiparous women to using LTCM in the Philippines and Indonesia. The six obstacles are living in rural areas, being younger, poor education, single, unemployed, and low wealth. Based on the findings of the research, the author recommend to the Philippines and Indonesia government to integrate the public health program and family planning program that can addres to the rural areas, teenagers, low education, unemployed group and poor people.

Availability of data and materials

The authors cannot publicly share the data because a third party and authors do not have permission to share it. The 2017 IDHS data set name requested from the ICF ‘data set of childbearing age women’ is available from the ICF contact https://dhsprogram.com/data/new-userregistration.cfm for researchers who meet the criteria for access to confidential data.

Abbreviations

LTCM:

Long-term contraceptive methods

IUD:

Intrauterine device

PDHS:

Philippines Demographic and Health Survey

IDHS:

Indonesian Demographic and Health Survey

ICF:

Inner City Fund

VIF:

Variance inflation factor

AOR:

Adjusted odds ratio

References

  1. Pusparisa Y. Southeast Asia’s rapid population growth (Pesatnya Pertumbuhan Populasi Asia Tenggara); 2019. p. 1–2.

    Google Scholar 

  2. Worldometer. South-Eastern Asia Population (LIVE). 2020.

    Google Scholar 

  3. Worldometer. Current world Population. 2020.

    Google Scholar 

  4. Creinin M, Simhan H. Can we communicate gravidity and parity better? Obstet Gynecol. 2020;113(3):709–11.

    Article  Google Scholar 

  5. Moore M. Crude birth rate in Southeast Asia in 2019, by country (in births per 1,000 population); 2020.

    Google Scholar 

  6. Philippine Statistics Authority and Inner City Fund. Key Findings from the Philippine National Demographic and Health Survey 2017. 2018. 1–20.

  7. Gafar A, Suza DE, Efendi F, Pramono AP, Susanti IA, Mishbahatul E. Determinants of contraceptive use among married women in Indonesia [ version 1 ; peer review : 2 approved]. F1000Research. 2020;6(APR):1–9.

    Google Scholar 

  8. Solanke BL, Banjo OO, Oyinloye BO, Asa SS. Maternal grand multiparity and intention to use modern contraceptives in Nigeria. BMC Public Health. 2018;18(1):1–15.

    Article  Google Scholar 

  9. Anguzu R, Sempeera H, Sekandi JN. High parity predicts use of long-acting reversible contraceptives in the extended postpartum period among women in rural Uganda. Contracept Reprod Med. 2018;3(1):1–7.

    Article  Google Scholar 

  10. Gashaye KT, Tsegaye AT, Abebe SM, Woldetsadik MA, Ayele TA, Gashaw ZM. Determinants of long acting reversible contraception utilization in Northwest Ethiopia: an institution-based case control study. PLoS One. 2020;15(10 October):1–19.

    Google Scholar 

  11. Zerden ML, Tang JH, Stuart GS, Norton DR, Verbiest SB, Brody S. Barriers to receiving long-acting reversible contraception in the postpartum period. Women’s Heal Issues. 2015;25(6):616–21.

    Article  Google Scholar 

  12. Luo Z, Gao L, Anguzu R, Zhao J. Long-acting reversible contraceptive use in the post-abortion period among women seeking abortion in mainland China: intentions and barriers. Reprod Health. 2018;15(1):1–9.

    Article  Google Scholar 

  13. Yaya S, Uthman OA, Ekholuenetale M, Bishwajit G. Women empowerment as an enabling factor of contraceptive use in sub-Saharan Africa: a multilevel analysis of cross-sectional surveys of 32 countries. Reprod Health. 2018;15(1):214. https://doi.org/10.1186/s12978-018-0658-5.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ontiri S, Ndirangu G, Kabue M, Biesma R, Stekelenburg J, Ouma C. Long-acting reversible contraception uptake and associated factors among women of reproductive age in rural Kenya. Int J Environ Res Public Health. 2019;16(9):1–11.

    Article  Google Scholar 

  15. Nita Adhani Pasundani1 KB. Determinant of the use of long-term contraceptive method: an analysis of 2017 Indonesian demographic health survey. Indian J Public Heal Res. 2020;11(5 SE):739–45 Available from: https://medicopublication.com/index.php/ijphrd/article/view/9426.

    Google Scholar 

  16. Getahun DS, Wolde HF, Muchie KF, Yeshita HY. Utilization and determinants of long term and permanent contraceptive methods among married reproductive age women at Janamora district, Northwest Ethiopia. BMC Res Notes. 2018;11(1):836 Available from: https://pubmed.ncbi.nlm.nih.gov/30477564.

    Article  PubMed  PubMed Central  Google Scholar 

  17. World Health Organization. World health statistics overview 2019: monitoring health for the SDGs, sustainable development goals. Geneva; 2019.

  18. Papp L, Kleiman M. Maternal Morbidity and Mortality Why do Filipino Mothers Die? 2020. p. 1.

    Google Scholar 

  19. Al-Shaikh GK, Ibrahim GH, Fayed AA, Al-Mandeel H. Grand multiparity and the possible risk of adverse maternal and neonatal outcomes: a dilemma to be deciphered. BMC Pregnancy Childbirth. 2017;17(1):1–7.

    Article  Google Scholar 

  20. Alsammani M, Ahmed S. Grand multiparity: risk factors and outcome in a tertiary hospital: a comparative study. Mater Socio Medica. 2015;27(4):244.

    Article  Google Scholar 

  21. Li L, Tran D, Zhu H, Balimane P, Willett G, Zhao P, et al. Use of model-informed drug development to streamline development of long-acting products: can these successes be translated to long-acting hormonal contraceptives? Annu Rev Pharmacol Toxicol. 2021;61:745–56.

    Article  CAS  PubMed  Google Scholar 

  22. Ilmiyah DE, Budihastuti UR, Nurhaeni IDA, Mudigdo A. Determinants of Women’s choice of a long-acting reversible contraceptive in Boyolali. Central Java J Matern Child Heal. 2018;03(03):225–32.

    Article  Google Scholar 

  23. Olson EM, Kramer RD, Gibson C, Wautlet CK, Schmuhl NB, Ehrenthal DB. Contraception in Wisconsin. WMJ. 2019;117(4):149–55.

    Google Scholar 

  24. Mazza D, Bateson D, Frearson M, Goldstone P, Kovacs G, Baber R. Current barriers and potential strategies to increase the use of long-acting reversible contraception (LARC) to reduce the rate of unintended pregnancies in Australia: an expert roundtable discussion. Aust New Zeal J Obstet Gynaecol. 2017;57(2):206–12.

    Article  Google Scholar 

  25. Garrett CC, Keogh LA, Kavanagh A, Tomnay J, Hocking JS. Understanding the low uptake of long-acting reversible contraception by young women in Australia: a qualitative study. BMC Womens Health. 2015;15(1):1–10.

    Article  CAS  Google Scholar 

  26. Faustmann T, Crocker J, Moeller C, Engler Y, Caetano C, Buhling KJ. How do women and health care professionals view hormonal long-acting reversible contraception? Results from an international survey. Eur J Contracept Reprod Heal Care. 2019;24(6):422–9.

    Article  CAS  Google Scholar 

  27. Wulandari RD, Qomarrudin MB, Supriyanto S, Laksono AD. Socioeconomic disparities in hospital utilization among elderly people in Indonesia. Indian J Public Heal Res Dev. 2019;10(11):1800–4.

    Google Scholar 

  28. Laksono AD, Wulandari RD, Efendi F. Determinants of hospital utilisation among urban poor societies in Indonesia. Int J Innov Creat Chang. 2020;12(9):375–87.

    Google Scholar 

  29. Seran AA, Antaria MD, Haksama S, Setijaningrum E, Laksono AD, Prahastuti Sujoso AD. Disparities of the use of hormonal and non-hormonal contraceptive drugs in urban and rural areas in Indonesia and the world. Syst Rev Pharm. 2020;11(9):66–73.

    Google Scholar 

  30. Seran AA, Laksono AD, Sujoso ADP, Masruroh II, Marasabessy N, et al. Does contraception used better in urban areas?: an analysis of the 2017 IDHS (Indonesia demographic and health survey). Syst Rev Pharm. 2020;11(11):1892–7.

    Google Scholar 

  31. Yadav K, Agarwal M, Shukla M, Singh JV, Singh VK. Unmet need for family planning services among young married women (15-24 years) living in urban slums of India. BMC Womens Health. 2020;20(1):187.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Yadav K, Agarwal M, Singh JV, Singh VK. Determinants of non-use of family planning methods by young married women (15-24 years) living in urban slums of Uttar Pradesh. Indian J Community Heal. 2017;29(1):55–66.

    Article  Google Scholar 

  33. Paul R, Huysman BC, Maddipati R, Madden T. Familiarity and acceptability of long-acting reversible contraception and contraceptive choice. Am J Obstet Gynecol. 2020;222(4):S884.e1–9.

    Article  CAS  Google Scholar 

  34. Wulandari RD, Laksono AD. The association of socioeconomic status on early marriage among women in rural Indonesia (Hubungan status ekonomi terhadap pernikahan dini pada perempuan di perdesaan Indonesia). J Kesehat Reproduksi. 2020;11(2):115–24.

    Article  Google Scholar 

  35. Onyowo UG, Namo IS. Effect of Early Marriage on Girl- Child ’ s Furthe r Education in Okpokwu Local Government Area , Nigeria : Implications for Counseling. KIU J Humanit. 2019;4(1):65–72.

    Google Scholar 

  36. Richards MJ, Coleman-Minahan K, Sheeder J. Long-acting reversible contraceptive attitudes and acceptability in adolescents and young adults: a key to patient-centered contraceptive counseling. J Pediatr Adolesc Gynecol. 2020;33(6):673–80.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Aduloju OP, Akintayo AA, Adefisan AS, Aduloju T. Utilization of Long-Acting Reversible Contraceptive (LARC) Methods in a tertiary hospital in southwestern Nigeria: A Mixed Methods Study. J Obstet Gynecol India. 2021.

  38. Eeckhaut MCW, Sweeney MM, Feng L. Desire for sterilization reversal among U.S. females: increasing inequalities by educational level. Perspect Sex Reprod Health. 2018;50(3):139–45.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Hayford SR, Kissling A, Guzzo KB. Changing educational differentials in female sterilization. Perspect Sex Reprod Health. 2020;52(2):117–27.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Laksono AD, Wulandari RD. The Barrier to Maternity Care in Rural Indonesia. J Public Heal From Theory to Pract. 2020.

  41. Wulandari RD, Laksono AD, Rachmawaty T, Rukmini. Barriers to antenatal care utilization in Indonesia. Medico-Legal Updat. 2021;21(1):828–34.

    Google Scholar 

  42. Rohmah N, Yusuf A, Hargono R, Laksono AD, Masruroh II, et al. Determinants of teenage pregnancy in Indonesia. Indian J forensic. Med Toxicol. 2020;14(3):2080–5.

    Google Scholar 

  43. Himawan KK, Bambling M, Edirippulige S. What does it mean to be single in Indonesia? Religiosity, social stigma, and marital status among never-married Indonesian adults. SAGE Open. 2018;8(3).

  44. Himawan KK. Singleness, sex, and spirituality: how religion affects the experience of being single in Indonesia. Ment Heal Relig Cult. 2020;23(2):1–12.

    Google Scholar 

  45. Bahamondes L, Fernandes A, Monteiro I, Bahamondes MV. Long-acting reversible contraceptive (LARCs) methods. Best Pract Res Clin Obstet Gynaecol. 2019;66:28–40.

    Article  PubMed  Google Scholar 

  46. Raccah-Tebeka B, Plu-Bureau G. Long-acting reversible contraception. Rev Prat. 2018;68(4):387–91.

    PubMed  Google Scholar 

  47. Allen S, Barlow E. Long-acting reversible contraception. Pediatr Clin N Am. 2017;64(2):359–69.

    Article  Google Scholar 

  48. Wulandari RD, Putri NK, Laksono AD. Socioeconomic Disparities in Antenatal Care Utilisation in Urban Indonesia. Int J Innov Creat Chang. 2020;14(2):498–514.

    Google Scholar 

  49. Beshar I, So J, Chelvakumar M, Cahill EP, Shaw KA, Shaw JG. Socioeconomic differences persist in use of permanent vs long-acting reversible contraception: An analysis of the National Survey of Family Growth, 2006 to 2010 vs 2015 to 2017. Contraception. 2021.

  50. Laksono AD, Matahari R, Wulandari RD. Factors related to the choice of contraceptive methods among the poor in Indonesia. Syst Rev Pharm. 2020;11(9):195–200.

    Google Scholar 

  51. Krashin JW, Stuart GS, Garrett J, Spector H, Bryant AG, Charm S, et al. Contraception insurance coverage and receipt of long-acting reversible contraception or depot medroxyprogesterone acetate on the day of abortion. Obstet Gynecol. 2017;130(1):109–17.

    Article  PubMed  Google Scholar 

  52. Fuerst MF, George KE, Moore JE. Long-Acting Reversible Contraception in Medicaid: Where Do We Go From Here? Women’s Heal Issues. 2020.

  53. Gerland P, Raftery AE, Ševčíková H, Li N, Gu D, Spoorenberg T, et al. World population stabilization unlikely this century. Science. 2014;346(6206):234 LP–237 Available from: http://science.sciencemag.org/content/346/6206/234.abstract.

    Article  CAS  Google Scholar 

  54. Laksono AD, Wulandari RD. “Children are assets”: Meta synthesis of child values in the Lani and Acehnese (“Anak adalah Aset”: Meta Sintesis Nilai Anak pada Suku Lani dan Suku Aceh). J Kesehat Reproduksi. 2019;10(1):11–20.

    Article  Google Scholar 

  55. Shoupe D. LARC methods: entering a new age of contraception and reproductive health. Contracept Reprod Med. 2016;1(1):4. https://doi.org/10.1186/s40834-016-0011-8.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Cleland J, Ali M, Benova L, Daniele M. The promotion of intrauterine contraception in low- and middle-income countries: a narrative review. Contraception. 2017;95(6):519–28 Available from: http://www.sciencedirect.com/science/article/pii/S0010782417300975.

    Article  PubMed  Google Scholar 

  57. Kroelinger CD, Morgan IA, DeSisto CL, Estrich C, Waddell LF, Mackie C, et al. State-Identified Implementation Strategies to Increase Uptake of Immediate Postpartum Long-Acting Reversible Contraception Policies. J Women’s Heal. 2018;28(3):346–56. https://doi.org/10.1089/jwh.2018.7083.

    Article  Google Scholar 

Download references

Acknowledgments

The author would like to thank Inner City Fund International, who has agreed to allow the authors to analyze the 2017 PDHS and the 2017 IDHS data in this article.

Funding

Not applicable.

Author information

Authors and Affiliations

  1. National Research and Innovation Agency, The Republic of Indonesia, Jakarta, Indonesia

    Agung Dwi Laksono

  2. Faculty of Health Science, Muhammadiyah University of Jember, East Java, Indonesia

    Nikmatur Rohmah

  3. Faculty of Public Health, University of Airlangga, Surabaya, Indonesia

    Hario Megatsari

Authors
  1. Agung Dwi Laksono
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nikmatur Rohmah
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hario Megatsari
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

ADL developed the proposal, analyzed and interpreted the data. NR and HM was a significant contributor in conducting the study, interpreting the data and writing the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hario Megatsari.

Ethics declarations

Ethics approval and consent to participate

The 2017 IDHS has passed ethical clearance from the National Ethics Committee. The authors delete all respondents’ identities from the dataset. Respondents have provided written approval for their involvement in the study through filling the informed concent. The author has obtained permission for the use of data for this study through the website: https://dhsprogram.com/data/new-user-registration.cfm. All methods were performed in accordance with the relevant guidelines and regulations.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Laksono, A.D., Rohmah, N. & Megatsari, H. Barriers for multiparous women to using long-term contraceptive methods in Southeast Asia: case study in Philippines and Indonesia. BMC Public Health 22, 1425 (2022). https://doi.org/10.1186/s12889-022-13844-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12889-022-13844-z

Keywords

BMC Public Health

ISSN: 1471-2458

Contact us