GENDER PERCEPTIONS ON CONTRACEPTION AMONG COUPLES

OF CHILDBEARING AGE IN JATINANGOR, SUMEDANG:

A COMPARATIVE STUDY

Dea Natalia1, Dini Pusianawati2, Irvan Afriandi3

Faculty of Medicine, Universitas Padjadjaran, 2Dept. of Obstetric and

Gynecology, Hasan Sadikin General Hospital, 3Dept. of Public Health, Faculty of

Medicine, Universitas Padjadjaran
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1. Dea Natalia
Faculty of Medicine, Universitas Padjadjaran
Jalan Raya Bandung-Sumedang Km. 21
Jatinangor, Sumedang, Indonesia
Telepon: +62 81519173322
Email: aquamarine_nyra@yahoo.com
2. Dini Pusianawati, dr., SpOG(K)
Department of Obstetric and Gynecology
Hasan Sadikin General Hospital
Jalan Pasteur No.38
Bandung, Indonesia
Telepon: +62 811225795
Email: diniobgin@gmail.com

3. Irvan!Afriandi,!dr.,!Dr.!PH
Department of Public Health
Faculty of Medicine, Universitas Padjadjaran
Jalan Raya Bandung-Sumedang Km. 21
Jatinangor, Sumedang, Indonesia
Telepon: +62 81320395588
Email: irvan.afriandi@gmail.com
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1!

Abstract
Background. Contraception use among couples of childbearing age is an
important part of family planning. Gender differences on family planning are
shown by lack of male participants in contraception use. Studies showed that
perception is one of the factors that influence ones participation in various
subjects. In this study, knowledge and perception level between males and
females among couples of childbearing age were compared to see whether there
were significant differences between the two.
Method. A quantitative cross-sectional analytic survey was conducted using an
interviewer-administered questionnaire on knowledge and perception about
contraception. 154 respondents or 77 couples of childbearing age were recruited
to participate from 12 villages in Jatinangor district, Sumedang, with multistage
sampling method from September-November 2014. Analysis of knowledge and
perception levels was done with SPSS Statistical 20.
Results. Contraception use among females was high (74.02% from total female
respondents, 37.01% from total respondents) while use among males was
considerably lower, only 2.59% from total male respondents or 1.29% from total
respondents. Mean knowledge and perception scores were higher in females as
compared to the males. Certain differences between males and females are noted
(Knowledge on IUD p<0.001, Perception on Tubal Ligation p=0.004).
Conclusion. There were significant differences on knowledge and perceptions
between male and female respondents regarding IUD and tubal ligation. No other
significant differences were found for other contraception.
Keywords. Contraception, Gender, Knowledge, Perception
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Abstrak
Latar Belakang. Penggunaan alat kontrasepsi di kalangan pasangan usia subur
adalah bagian penting dalam program keluarga berencana. Ketimpangan gender
dalam program keluarga berencana ditunjukkan oleh rendahnya partisipasi pria
dalam penggunaan alat kontrasepsi. Penelitian menunjukkan persepsi adalah salah
satu faktor yang mempengaruhi partisipasi seseorang dalam berbagai kegiatan.
Dalam penelitian ini, pengetahuan dan persepsi pria dan wanita mengenai alat
kontrasepsi di kalangan pasangan usia subur dibandingkan untuk melihat adanya
perbedaan yang signifikan diantara keduanya!!
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Metode, Survei analitik kuantitatif potong lintang dilaksanakan dengan kuesioner
tentang pengetahuan dan persepsi mengenai alat kontrasepsi. Sampel sebanyak
154 responden atau 77 pasangan usia subur diperoleh dari 12 desa di kecamatan
Jatinangor, Sumedang, dengan metode sampling gugus bertahap pada SeptemberNovember 2014. Analisa pengetahuan dan persepsi dilakukan dengan
menggunakan SPSS Statistical 20.
Hasil. Tingkat penggunaan alat kontrasepsi pada wanita tinggi (74.02% dari total
responden wanita, 37.01% dari total responden) sedangkan tingkat penggunaan
pada pria lebih rendah, hanya 2.59% dari total responden pria atau 1.29% dari
total responden. Rata-rata nilai pengetahuan dan persepsi lebih tinggi pada wanita
dibandingkan dengan pria. Perbedaan pada nilai antara pria dan wanita terlihat
pada pengetahuan mengenai IUD (p<0.001) dan persepsi mengenai MOW
(p=0.004).
Simpulan. Terdapat perbedaan signifikan pada pengetahuan dan persepsi pada
pria dan wanita mengenai IUD dan MOW. Tidak ditemukan adanya perbedaan
signifikan untuk kontrasepsi lainnya.
Kata Kunci, Kontrasepsi, Gender, Pengetahuan, Persepsi
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Background
Family planning in Indonesia is taken into account by Badan Kependudukan dan
Keluarga Berencana Nasional (BKKBN). Originally, family planning was
directed more on demographical aspect with focus on decreasing fertility and
population rate. However, ever since International Conference on Population and
Development (ICPD) 1994 took place, there was a change of paradigm in family
planning, focusing more on reproductive rights and gender equality1.
Contraception is expected to be used both by male and female spouses of
couple of childbearing age. Ideally, the use of contraception should be a shared
responsibility2. However, as reported by BKKBN Bandung and Unit Pelaksana
Teknis Badan Keluarga Berencana (UPTB KB) Jatinangor, contraception use was
still dominated by female participants3. This condition highlighted the fact that
there were gender differences regarding contraception use.
Gender differences in contraception use is furthermore elaborated in other
studies. One study discussed that one of the reason there was lack of male
contraception use is because there is a tradition or habit in the community to
delegate the task of family planning to the women4. A previous study also showed
gender bias in terms of contraception use among couples of childbearing age. One
of the factors discussed in the study was gender ideology, in which contraception
use is regarded as one of womens roles in the community5. These gender
discrepancies cause inequalities in terms of reproductive rights and health,
especially for women. An increase of participation in contraception use by men is

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necessary to elevate reproductive health both in women and men, gender equality,
and subsequently, increased quality of contraception providers6.
Knowledge is related to perception. Better understanding of certain
subjects would cause people to have more readiness to accept it. This notion is
often referred to as perceptual set. Basically, it is the tendency to perceive or
notice some aspects of the available sense data and ignore others. Liew summed
up that knowledge is a mixture of data and information acquired by an individual,
involves the belief and experiences of the individual and strongly tied to ones
action7.
Meanwhile, perception is the process by which organism interpret and
organize sensation to produce a meaningful experience of the world8. In other
words, perception is defined as an act of being aware of ones environment, which
denotes an individuals ability to understand. Thus, perception explains why
certain person acts or behaves in a different way from other person and interprets
stimuli differently although it was experienced similarly9. Studies showed that
perception is one of the factors that influence ones participation in various
subjects10, 11. Thus, it can be inferred that higher level of participation is related to
higher level of knowledge and overall better perception.
The aim of the study presented in this article was to compare knowledge
about and perceptions of contraception between males and females among couples
of childbearing age in Jatinangor, Sumedang, to see whether there were
significant differences between the two.

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Methods
This study was designed as a cross sectional, observational survey. The Health
Research Ethics Committee Universitas Padjadjaran approved this study in
September 5th, 2014 (No. 285/UN6.C2.1.2/KEPK/PN/2014). Before the
questionnaires were given, a written informed consent form regarding the method,
purpose, and meaning of this survey was provided to the respondents. If the
respondents wished to take part in the survey, they were asked to affix their
signatures on the page. Written informed consent forms were obtained from all
respondents prior to the investigation.

Subjects of the study

The criteria for eligible participants were as follows: (1) couples of childbearing
age with the female aged 15 to 49 years, (2) residing at one out of 12 villages in
Jatinangor, and (3) can provide written informed consent. The excluding criteria
were: (1) the inability to be contacted by interviewer and (2) failure to finish
answering the study questionnaire.

Sampling strategy
12 administrative zones were each selected out of the 12 villages in Jatinangor
district, Sumedang from September to October 2014. One community was
randomly selected from each zone. Subjects were randomly recruited from each
community. Respondents following the research was up to 166 individuals, or 83
couples of childbearing age; with 77 couples fulfilled inclusion criteria, passing

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the 38 couples minimum samples criteria; while 6 couples either decline to

continue their participation in this study or unable to finish answering the
questionnaires.

Statistical methods
A questionnaire, prepared in the Indonesian language, was administered to each
study participant after previously validated using statistical software SPSS version
20, with a total of 58 questions on knowledge and 70 questions on perceptions.
This questionnaire sought to obtain information on socio-demographic
characteristics, knowledge and perceptions on various contraception. Knowledge
was scored with Guttman scale while perception was scored with Likert scale.
To test the statistical significance between groups, Wilcoxon signed-rank
test was used for measurement variables and chi-square test was used for
categorical variables. The inclusion P value was 0.05. Statistical software SPSS
version 20 was utilized to perform the statistical analyses.

Results
Table 1 shows the demographic of the respondents. A total of 77 couples or 154
respondents were examined. The majority of male respondents age was 36-49
years old, while the females was mostly 21-35 years old. Both male and female
respondents had mostly completed their education up to senior high level,
however there were still female respondents who did not graduate from primary
school. Most male respondents were employed as private employees, while the

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female respondents were mostly formally unemployed. The average monthly

income of the couples of childbearing age was less than 1 million rupiahs, which
was lower than Sumedang district Minimum Wage Standard of 1,735 million
rupiahs. Regarding the age at which the male and female respondents were first
married; the male respondents were mostly married at age 21-35 years old, while
the females were mostly married under 21 years of age. Almost all respondents
are in their first marriage, with only 4 men and 3 women stating that the marriage
they are currently in is not their first marriage.
Table 2 shows the types of contraception known and ever used by the
respondents. Injectables was the type of contraception commonly known
(94.15%), followed by pills (82.46%), while the least commonly known
contraception was the rhythm (calendar) method (3.89%). The proportion of the
type of contraception most commonly used reflected the type of contraception
known. The most commonly used type of contraception by the female
respondents was injectables (29.87%), followed by pill (14.28%). Meanwhile,
only 2 respondents out of 77 male respondents were using contraception. The type
of contraception used by the male respondents was vasectomy. It was also
observed that there were still respondents who were not using contraception,
consisting of 20 female respondents (25.97%) and 75 male respondents (97.40%),
adding up to 95 respondents or about 61.68% of total respondents.

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Table.1 Socio-demographic Characteristics

Male (n=77)
Age (years)
20
21-35
36-49
50
Highest education level
part primary
completed primary
completed junior high
completed senior high
bachelor degree and higher
Employment status
labor
farmer
government employee
private employee
entrepreneur
unemployed
Monthly income
< 1 million rupiahs
1 3 million rupiahs
> 3 million rupiahs
Age at first marriage (years)
20
21-35
36-49
50
unspecified
Number of previous marriages
0
1

Female (n=77)

Total (n=154)

28 (36.36%)
44 (57.12%)
5 (6.49%)

2 (2.59%)
41 (53.24%)
34 (44.15%)
-

2 (1.29%)
69 (44.80%)
78 (50.64%)
5 (3.24%)

20 (25.97%)
21 (27.27%)
31 (40.25%)
5 (6.49%)

2 (2.59%)
11 (14.28%)
30 (38.96%)
32 (41.55%)
2 (2.59%)

2 (1.29%)
31 (20.12%)
51 (33.11%)
63 (40.90%)
7 (4.54%)

10 (12.98%)
8 (10.38%)
3 (3.89%)
31 (40.25%)
23 (29.87%)
2 (2.59%)

1 (1.29%)
1 (1.29%)
8 (10.38%)
5 (6.49%)
62 (80.51%)

11 (7.14%)
8 (5.19%)
4 (2.59%)
39 (25.32%)
28 (18.18%)
64 (41.55%)

38 (49.35%)
33 (42.85%)
6 (7.79%)

38 (49.35%)
28 (36.36%)
11 (14.28%)

76 (49.35%)
61 (39.61%)
17 (11.03%)

8 (10.38%)
67 (87.01%)
1 (1.29%)
1 (1.29%)

46 (59.74%)
31 (40.25%)
-

54 (35.06%)
98 (63.63%)
1 (0.64%)
1 (0.64%)

73 (94.80%)
4 (5.19%)

74 (96.10%)
3 (3.89%)

147 (95.45%)

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Table.2 Types of Contraception Known and Used

Contraception Known
injectables
pill
implant
IUD
tubal ligation
vasectomy
rhythm/calendar method
withdrawal method
condom
others
Current Contraception Use
injectables
pill
implant
IUD
tubal ligation
vasectomy
rhythm/calendar method
withdrawal method
condom
others/unspecified
not using contraception

Male (n=77)

Female (n=77)

Total (n=154)

70 (90.90%)
63 (81.81%)
37 (48.05%)
36 (46.75%)
15 (19.48%)
14 (18.18%)
5 (6.49%)
8 (10.38%)
37 (48.05%)
1 (1.29%)

75 (97.40%)
64 (83.11%)
49 (63.63%)
52 (67.53%)
29 (37.66%)
24 (31.16%)
1 (1.29%)
3 (3.89%)
39 (50.64%)
-

145 (94.15%)
127 (82.46%)
86 (55.84%)
88 (57.14%)
44 (28.57%)
38 (24.67%)
6 (3.89%)
11 (7.14%)
76 (49.35%)
1 (0.64%)

2 (2.59%)
75 (97.40%)

23 (29.87%)
11 (14.28%)
4 (5.19%)
7 (9.09%)
5 (6.49%)
7 (9.09%)
20 (25.97%)

23 (14.93%)
11 (7.14%)
4 (2.59%)
7 (4.54%)
5 (3.24%)
2 (1.29%)
7 (4.54%)
95 (61.68%)

Table 3 presents the findings on contraception knowledge among the couples.

Compared with the female respondents, the male respondents generally had lower
mean score on knowledge, except on knowledge on condom (3.51 vs. 3.31).
Statistical test for knowledge difference on IUDs elicit a statistically significant
result (Z = -3.609, p < 0.001). Median knowledge rating for males was 4 and for
females was 5.

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Table.3 Knowledge on Contraception

Male

Female

Statistics

Z = -0.930
p = 0.35

Condom
maximum (6)

3.51 1.984

3.31 1.948

43

43

maximum (3)

Z = -1.550

minimum

p = 0.12

0.71 0.998

0.91 1.041

02

02

maximum (5)

Z = -1.425

minimum

p = 0.15

1.27 1.699

1.58 1.641

03

13

10

10

Z = -1.110
p = 0.26

minimum
mean SD
median IQR
Vasectomy

mean SD
median IQR
Tubal Ligation

mean SD
median IQR
Injection
maximum (10)

5.09 3.208

5.38 2.734

55

54

maximum (12)

12

12

Z = -1.853

minimum

p = 0.06

5.09 3.297

5.61 2.691

45

64

minimum
mean SD
median IQR
Pill

mean SD
median IQR

Traditional (rhythm/calendar method, withdrawal method)

7
7
maximum (7)

Z = -1.609

3.22 2.674

3.74 2.707

36

46

maximum (10)

10

10

Z = -3.609

minimum

p < 0.001

3.18 2.905

4.40 2.988

45

54

maximum (5)

Z = -1.703

minimum

p = 0.08

2.16 1.885

2.57 1.705

24

33

minimum
mean SD
median IQR

p = 0.10

IUD

mean SD
median IQR
Implant

mean SD
median IQR

* maximum score of each category is determined by maximum number of questions on each category

11!

Table.4 Likelihood of Having Knowledge on Contraception

Condom
Female
Male
Vasectomy
Female
Male
Tubal Ligation
Female
Male
Injection
Female
Male
Pill
Female
Male
Rhythm (Calendar) Method
Female
Male
Withdrawal Method
Female
Male
IUD
Female
Male
Implant
Female
Male

Yes

No

Crude OR 95% CI

39
37

38
40

1.00
0.901 (0.479, 1.696)

24
14

53
63

1.00
0.491 (0.231, 1.043)

Statistics
p = 0.74
p = 0.062
p = 0.013

29
15

48
62

1.00
0.400 (0.193, 0.830)*

75
70

2
7

1.00
0.267 (0.054, 1.327)

64
63

13
14

1.00
0.914 (0.398, 2.099)

1
5

76
72

1.00
5.278 (0.602, 46.275)

3
8

74
69

1.00
2.860 (0.729, 11.219)

52
36

25
41

1.00
0.422 (0.219, 0.812)*

49
37

28
40

1.00
0.529 (0.277, 1.007)

p = 0.086
p = 0.832
p = 0.096
p = 0.118
p = 0.009
p = 0.051

Table 4 shows significance on knowledge about contraception on couples of

childbearing age. Generally, women were significantly having more knowledge
on tubal ligation and IUD.
Table 5 presents the findings on perception score among the couples.
Compared with the female respondents, the male respondents generally had lower
perception score, except regarding IUD (18.26 vs. 18.04). Statistical test for
perception difference on Tubal Ligation elicit a statistically significant result (Z =
-2.888, p = 0.004). Median perception rating for males was 22 and for females
was 25.

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Table.5 Perception on Contraception

Male

Female

Condom
58
59
maximum (60)
10
10
minimum (10)
28.99

10.083
29.97

11.574
mean SD
26 15.50
27 16.50
median IQR
Vasectomy
30
30
maximum (30)
5
5
minimum (5)
16.53 6.684
17.53 6.088
mean SD
16 11
18 10
median IQR
Tubal Ligation
42
42
maximum (42)
7
9
minimum (7)
22.38 8.766
25.32 8.136
mean SD
22 14
25 11.50
median IQR
Depot/Injection
35
36
maximum (36)
8
9
minimum (6)
21.06 5.327
21.87 5.865
mean SD
21

6
21 7
median IQR
Pill
36
36
maximum (36)
10
10
minimum (6)
24.90

5.801
26.01
5.454
mean SD
25 8
26 7
median IQR
Traditional (rhythm/calendar method, withdrawal method)
30
30
maximum (30)
5
5
minimum (5)
18.05 6.200
18.32 6.233
mean SD
19 9.50
19 9
median IQR
IUD
30
30
maximum (30)
5
5
minimum (5)
18.26 5.807
18.04 6.101
mean SD
20 8
16 9
median IQR
Implant
24
24
maximum (24)
4
8
minimum (4)
15.90 4.558
16.53 4.521
mean SD
16

7
17 6
median IQR

Statistics
Z = -0.026
p = 0.97

Z = -0.841
p = 0.40

Z = -2.888
p = 0.004

Z = -0.761
p = 0.44

Z = -1.392
p = 0.16

Z = -0.285
p = 0.776

Z = -0.446
p = 0.656

Z = -0.519
p = 0.60

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Social Norms
maximum (90)
minimum (15)
mean SD
median IQR
Accessibility
maximum (42)
minimum (7)
mean SD
median IQR

78
41
59.90 8.210
60 13

79
46
61.01 8.212
61 12

Z = -1.227
p = 0.22

42
12
30.01 5.243
30 4.50

41
12
30.69 5.413
32 4

Z = -1.474
p = 0.141

* maximum score is determined by maximum number of questions on each category

Table.6 Likelihood of Participation in Contraception Use

Participation
Female
Male

Yes

No

Crude OR 95% CI

57
2

20
75

1.00
0.009 (0.002, 0.042)

Statistics
p < 0.001

Table 6 shows significance on participation on contraception among couples of

childbearing age. Generally, women were significantly more likely to use
contraception than men.

Discussion
Findings show that the female respondents are younger, being married at earlier
age, and mostly unemployed. Considering the average of monthly income of the
respondents in this study, most of the couples in this study were of lower
socioeconomic status. The most commonly known and used type of contraception
by the respondents was injection, followed by pills. This trend in knowledge on
contraception and contraceptive use is consistent with those reported in
Indonesian Demographic and Health Survey (IDHS) 2012. The number of

14!

marriage the couples are currently in may or may not play a role in terms of the
type of contraception currently being used by the couples.
The fairly high number of respondents who were reported not using any
contraception was due to a few reasons; (1) the female spouse of the couples were
in pregnancy, (2) either the male or female spouse was planning on pregnancy or
wanting to have more children, and (3) other reasons, including considering self
as being old thus no longer productive, having certain illness or limitations, or
having tried a few types of contraception yet none was suitable, or especially for
the men, the other spouse had already been using contraception.
The male respondents generally had some knowledge about contraception.
However, their level of such knowledge was lower than that of the female
respondents. The likelihood for male respondents of having the knowledge on
contraception was also lower compared to the female respondents concerning
tubal ligation and IUD. Regarding perception level, the male respondents
generally have similar perceptions on contraception compared to the female
respondents; however, the female respondents have slightly better perception on
contraception.
In this study, there were found few discrepancies regarding knowledge and
perception level. It is known that higher participation level was related with better
perceptions, while better perceptions were the result of higher level of knowledge.
With significantly lower male participation level in contraception among couples
of childbearing age in this study, it was expected that the males would have had
significant difference in knowledge and perception level compared to the female

15!

respondents. However, results show that there is lack of significant differences

regarding knowledge and perception level between the male and female
respondents.
The lack of differences in perceptions might be explained by the fact that
male respondents were more indifferent about contraception use, leading to a
yes attitude regarding the option of female contraception available for his
spouse, as long as his spouse experienced no adverse effect while using the
contraception.
On the other hand, lack of significant differences on knowledge and
perceptions between male and female respondents may indicate that indeed the
knowledge and perceptions about contraception of male respondents are similar to
that of the females. This may imply increased concern about contraception from
the male respondents. However, due to the substantial gap between the number of
men showing positive perceptions about contraception and the number of men
actually using contraception, this study could not explain why male participation
level regarding contraception was still low. Although, when compared, the
likelihood of men to use contraception was also much lower than women.
Future efforts must focus on further increasing both mens and womens
knowledge about contraception, as mean knowledge score for both men and
women were still less than 50% of total attainable score, except for condom,
injection, traditional method (rhythm and withdrawal method), and implant. The
objective of this effort was to prepare the couples to make a fully informed
method choice. The high number of couples of childbearing age with risk of

16!

having high-risk pregnancy highlight the need for further improved family
planning counseling for all couples, especially about safe, effective, and long-term
contraceptive options, such as IUD and tubal ligation.

Conclusion
There were no significant differences on knowledge and perceptions between
male and female respondents regarding contraception, except on knowledge about
IUD and perceptions about tubal ligation. The overall mean score for knowledge
for both men and women were lower than 50% of the attainable score; with the
women being more likely to score higher than men. Meanwhile, perception score
of both men and women were similarly quite high. Relating to participation in
contraception use, it was found that women were more likely to use contraception
compared to men.

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