Journal of Health Sciences and Medicine, Vol. 1 No. 2, September 2017

27

Perception Of Contraception Access And Utilization In Teenagers In Senior High School No 8 Denpasar, Bali

R Listyowati¹, NMS Nopiyani1, PA Indrayathi1

1Public Health Program, Faculty of Medicine, Udayana University, Bali, Indonesia E-mail : [email protected]

Abstract

The images of teenagers in the world, especially in South Asia and Southeast Asia have less information about reproductive and sexual health because of the assumption that it is unnecessary even considered harmful if they knew it. It’s not surprise that the teen birth rate is still quite high. previous research in Indonesia on adolescent premarital sexual behavior, obtain a yield of about 25% - 51% of teens have sex before marriage. (Utomo ID 2009; 40 (2) :. 133-46.). Studies in Bali obtain the results of teenage boys in high school (SMA) and junior high school (SMP) more premarital sex (40.3% and 29.4%) than girls (3.6% and 12.5%). Teenage boys in Bali more permissive toward premarital sexual behavior than girls and about 5% of teens have sex before marriage (Faturochman 1992; 1 :. 12-7) Adolescents have a right to a healthy life. They need to have access of the tools that can protect their health, such as condoms, contraception and youth-friendly health services are comprehensive. Governed by Law no. 36/2009 Article 4 and 5, which states that everyone has the same right to gain access of health and this rule does not see marital status. The purpose of this study was to describe the general perception of access and use of contraception among adolescents in the city of Denpasar.

Keywords: Access, Adolescent, Contraception, Perception, Utilization

  • I.    INTRODUCTION

Teenager is considered as the group of society that easily affected by information whether it is positive or negative. The most influenced ones are those that disseminate by mass media such as magazine, newspaper, tabloids, as well as electronic media like radio, television, and internet. As stated in various data that collected in SKRRI 2007 about the information that mostly liked by teenagers, the information delivered to teenagers should be entertaining in nature. The sexual and reproductive health problem is considerably important for teenagers since they are considered to be sexually active. The term sexual and reproduction health was first described in International Conference on Population and Development (ICPD) which was held in Cairo in 1994.

In research conducted by Foumane et.al (2012) among female teenagers in Senior High School in Cameroon urban area, it was found that as teenagers get older, the more likely they had active sexual habit. This problem is clearly lead to undesirable effect in the future. The teenagers that have been introduced to sexual intercourse and drugs tend to have higher risk of contracting HIV/AIDS. In addition, undesirable pregnancy is also the consequence of active free sex behavior that mostly ignored by teenagers. Undesirable

pregnancy can be defined as pregnancy that occurred because of several factors so that it is not desired by the mother or family. The associated factors are inadequate knowledge about pregnancy process, rape, and failure of contraceptive or others methods of pregnancy prevention., Family planning is one part of Reproductive Health Program. The knowledge about device/method of family planning in  Indonesian  teenagers in the  Teenagers

Reproductive              Health              Survey

(SurveiKesehatanReproduksiRemaja/SKRRI)  2007 was

obtained by  asking the  respondent to  mention the

device/method of family planning that can be used by married couple to prevent pregnancy. Almost all respondents had ever been known about at least one of the modern device/method of family planning, The knowledge of family planning was little bit lower among male and female teenagers compared to married female respondent aged 15-49 years and male respondent aged 15-45 years that were interviewed in Indonesia Health and Demographic Survey (Survei Demografi dan Kesehatan Indonesia/SDKI) 2007. Injection, pils, and condom were commonly known by female and male teenagers.

In Indonesia, the teenager birth rate in rural areas is almost two times higher than in urban areas with 62 births per 1000 people compared to 35 per 1000 in urban areas. While the contraception has been introduced in the same time as family planning program, there are still a lot of rumors and stigma about contraception including pregnancy. Family planning includes two categories namely communication, Information, Education, and Counseling aspects and contraception device service aspect. According to SKRRI 2007, both aspects were attracting the interest of unmarried teenagers. Nevertheless, providing contraceptive devices for unmarried couple is not part of National Family Planning Program. To understand about the desire of the respondent to use family planning device/methods, they are asked whether they would use the devices/methods in the future. Through this further analysis, it also observed whether the female and male teenagers want the device/method of family planning to be available for those who are not yet married when they need it.

From August 2002 until August 2003, KISARA PKBI Bali had conducted a survey about the dating attitude and behavior and sexual activity in grade 3 students of Junior High School and fist grader of Senior High School (Those who were ≤ 17 years old) in Denpasar, Badung, Tabanan, and Gianyar. It revealed that 526 (23.75%) respondent had ever been dating from 2215 respondents. However, none of them agreed about sexual intercourse before marriage. The same results were obtained in the question whether petting, anal sex, or oral sex is allowed before marriage. 44.15% respondents indeed agreed that masturbation is allowed and acceptable while other agreed that lips kiss (21.58%) and forehead/cheek kiss (55.85%) are allowed. However, when asked about the activities that they had conducted before (among those who had girl/boyfriend), 2.28% were found to had sexual intercourse and 0,57% had conducted petting, anal sex, or oral sex. 13.12% had been had lips kissing, 26.24% had forehead or cheek kissing, and 51.63% of male respondent had masturbation while only 3,32% female respondent had masturbation.

The aforementioned findings indicate that today’s teenagers had high risk sexual behavior and even having unwanted pregnancy. Until June 2014, 18.237 of teenagers had HIV & AIDS(Ditjen PPM & PL Depkes RI). Meanwhile, until June 2014, the cumulative percentage of AIDS in 20-29 years age group was 32.9% (Kemenkes RI, 2014).

The most important thing that needs to be delivered together with contraception is education/knowledge. Nowadays, the knowledge of reproductive health is still considered as taboo for teenagers while the opposite phenomenon occurred in the society. The reproductive health information should not only contain sexuality and contraceptive but also

how to manage sexual desire and how to prevent violence and healthy relationship that would be beneficial when they married. It also includes how to select appropriate contraception methods, the promise of couple supports, and who will use the contraception.

Teenagers have right to live a healthy life. They need access to devices that could protect their health such as condom, contraception, and comprehensive friendly teenager health services. As stated in government act no 36/2009 article 4 and 5, every person has the same right to access to health service and this regulations does not mentioned about marriage status. According to aforementioned problems, the authors aim to evaluate the perception about contraceptive access and utilization among teenagers in Denpasar.

  • II.    METHODS AND PROCEDURES

Place and Time of the Reseanrch

The research was conducted in Denpasar for 6 months of data collection.

Study Design

This research is a descriptive research with qualitative method. Based on the timing of data collection, this research is a cross-sectional research because all of the data were collected in one time only to describe the situation and activity on the respective time.

Study population and Sample

Study Population

The target populations of this research were Public Senior High School and Private Senior High School students. The reached populations were high school students aged between 15-17 years old located in Denpasar which numbered 10.465 students, parents, and teachers.

Research Sample

The purposive sampling method were used in this research. According to Notoadmojo (2010) in Rutu et.al (2012), purposive sampling can be described as sample collection that conducted based on certain author’s consideration which usually according to certain characteristic or the nature of the population.

In this qualitative research, appropriateness and adequacy principles were used. Appropriateness means the informant was selected according to the research topic while adequacy means that the data collected could describe the real situation based on the research topic and sufficient to support research analysis.

In this case, researchers selected 10 respondents which would act as informant that considered being capable and

willing to participate in the research. The informants in this research consisted of 6 students from Senior High School No 8, 2 from each grade (female and male), 1 from each student’s parents, and 1 head master of Senior High School No 8.

Research Instrument

In the data collection process, the main instrument was the researchers. The interview guidelines were used to ensure the efficiency of interview process supported by using recorder to document and helped the researcher rewind the interview.

Qualitative Research Procedures Data Collection

Senior High School No 8

Students

No

Age (years)

Sex Type

N

Male

Female

1

15 years

1

1

2

2

16 years

1

1

2

3

17 years

1

1

2

Total

3

3

6

Headmaster

No

Age (years)

Sex Type

N

Male

Female

1

55 years

1

1

Total

1

1

Student’s Parents

No

Age (Years)

Sex Type

N

Male

Female

1

40 years

1

1

2

45 years

1

1

3

58 years

1

1

Total

1

2

3

In qualitative research, primary data were collected by deep interview to deeply understand the perception about access and utilization of contraception among teenagers in Denpasar as well as to understand the perception of Senior High School No 8 students, parents, and the headmaster and social context that experienced by participants regarding the access of contraception for teenagers today. The data includes commentary and narration acquired from verbal information from participant. Secondary data were obtained from written documents about the students in the school.

Data Analysis

This research used the thematic analysis with several step as follows:  Constructing the deep interview transcript.

Composing the coding by processing the data fragments into smaller meaningful units followed by categorizing the units. Re-reading deeply the interview transcripts to recode and creating a information categories by grouping similar information from the coding process and each category would be analyzed according to research theme. Lastly, interpreting the information, making detailed analysis narration about the feeling, opinion, and perception of the participant.

Research Ethic

Prior conduction the research, the researchers were applied a permission to Bali Province and Denpasar Health Research and Development Department followed by applying permission to the location of the research with a copy to Denpasar Educational Department. Because the respondents were the society, the researchers also asked permission and Ethical Clearance from Ethical Commision of Faculty of Medicine Udayana University. After the permissions had been obtained, the researchers arranged the timing of the research with respondents in research site. After all preparation had been completed, the research began with the respondents need to be agreed to participate as respondent and informant by signing agreement letter. The researchers are oblique to guarantee the confidentiality of the data from respondents and informants and there was should be no coercion.

  • III.    RESULTS AND DISCUSSION

General Description of Research Location

The research was conducted in Senior High School No 8 located at Antasura Street (PeguyanganKaja) Denpasar which consist of 39 class rooms with 389 first grade students, 434 second grade students, and 328 third grade students. There were also 58 teachers and 9 employees staff. There were some supporting teaching facility such as 1 chemistry laboratory, 1 physic laboratory, 1 library, and canteen as well as a place for extracurricular such as basketball yard.

The Distribution of Respondent’s Characteristics (Informant)

Tablel 1.The characteristic distribution of the perception about the access and utilization of contraception in teenagers in Senior High School No 8 Denpasar

As described in Table 1, there was 10 respondents that act as informant which consisted of 6 students (3 male and 3 female students) from Senior High School No 8, 3 parents

and 1 headmaster, the headmaster of the school itself. The age range of the respondent was between 14 to 58 years old.

Naration of The Result and Discussion

The result and discussion is divided according to research theme and presented as narration as follows.

From the result of the interviews and research discussion, it can be concluded: (1) from knowledge perception, the teenagers know about the benefit of contraception to prevent the pregnancy and protect the genital organs against sexual transmitted disease. It is in line with the theory that state that contraception is to avoid or prevent the process of pregnancy which results from the fertilization of ovum by sperm. According to that statement, the contraception is needed by sexually active couples and both of them should be fertile but do not want to be pregnant. (2) From the attitude description, most teenagers agreed that the access to contraception should be limited by marriage status. (3) According to their experiences, especially from those who sexually active, they have seen their fellow teenagers easily bought the contraceptive device in minimarts without any difficulties. (4) From contraception access and utilization information sources and support from parents, most teenagers said that their parents never gave them any sexual education and information about contraception while their teachers never discussed or give any feedback regarding the easy access to contraception. (5) About the free sex, sex before marriage, and access to get the contraception among the teenagers, it is difficult to surveillance their outdoors activity and this is difficult obstacle for parents and teachers. Also, the socialization tends to create a dilemma because the teenagers perceived that they are allowed to have sex as long as they use contraception.

  • IV.    CONCLUSION

From the description of the knowledge about contraception, all informants stated that they were known about the term and meaning of contraception as device to avoid or prevent pregnancy according to the type. Most informants stated that free sex is unreasonable because of easy access to contraception, but some perceived that as acceptable because they were fully aware about the consequences.

From the description about the usage and access support to contraception as well as sexual education, these aspects had not been given by school or parents because it was considered as taboo. From the contraceptive usages perspective, it is concluded that sexual education is needed to prevent the negative sexual attitude such as sex before marriage and direct the teenagers toward a healthy relationship and date.

ACKNOWLEDGMENTS

The authors would like to thank to the Research and Development Department of Faculty of Medicine Udayana University as the funding body and Research and Public Service Department that had allowed us to participate in National Scientific and Technology Seminar (Seminar NasionalSainsdanTeknologi/Senastek) in the University level. The authors also thank the headmaster of Senior High School No 8 and student’s parents for the information and all of the students of Senior High School No 8 that had participated in this research.

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