STEP 7

1. What the purpose of the contaraseption?

Jawab :
According to WHO (2003) purpose of KB are:
 Postpone / prevent of pregnancy. Delaying pregnancy for PUS (spouses of fertile age) with a wife
aged less than 20 years are encouraged to postpone pregnancy. Reasons delay / prevent
pregnancy:
a. Under 20 years of age is the age to should not have a child because variety of reasons.
b. Priority use of oral contraceptive pills, because the participants are young.
c. Using condoms is less profitable because the young couple coitus interuptus still high
frequency, so it’s have a high failure.
d. Using IUD (Intra Uterine Divice) those who not yet have a children so it’s can be
recommended, especially for applicants with contraindication to oral pills.

 Purpose of KB
a. demographics purpose that prevent overpopulation by pressing the population growth rate
(LLP) and of course will be followed with decrease of birth rate
b. Adjusting pregnancy by delaying marriage, delaying pregnancies for the first child, and give
space between first child and to the next child, if the moms feels enough for the child so she
can stop to have a child.
c. Married Conseling for young people or couples getting married so it’s hope that the couple will
have the knowledge and understanding to build happy family and good quality.
d. The final goal is to achieve NKKBS KB (Norma Small Family Happy and Prosperous) and
make a quality family, family quality it’s means a harmonious family, health, adequate food,
clothing, housing, education and economically productive
Sumber : BKKBN, 2004. Keluarga Berencana dan Kesehatan Reproduksi: Kebijakan Program dan
Kegiatan tahun 2005-2009. Jakarta: BKKBN.

2. What kind method of contraception?

Answer :
Various methods of contraception :
 Simple Method
Simple contraception without tools, that,s can with coitus interruptus and periodic abstinence.
While contraceptive devices / drugs, one of them can be done by using condoms.
 Modern Methods / Effective
a. Hormonal contraception
- orally: Pills
- Injection / injection
- subcutis: Implant (Contraceptive Down Leather = AKBK)
b. Intra Uterine Devices (IUD)
c. contraception Steady (mantap)
In women: radiation, Operative (Medical Operative Women / MOW)
Mechanically fallopian tube blockage
In men: Operative (Medical Operative Male / MOP), blockage of the vas
deferens mechanically, chemically Blockage of the vas deferens
 sumber : Kusumaningrum Radita.2009.Faktor-faktor yang Mempengaruhi Pemilihan Jenis
Kontrasepsi yang Digunakan Pada Usia Subur.Semarang:FK Undip
3. What are advantage and disadvantage from contracaption?
Answer :
Contraseptive Advantages Disadvantages
Hormonal Pills - easy to use and easy to get Not suitable for forgetfull patients
- decrease blood loss (due to
menstruation) and pain
menstruation
- decrease the risk of KET (ectopic
pregnancy disturbed) and Ovarian
Cysts
- reducing the risk of ovarian and
uterine cancer
Injection - Reduce patients visit ---
- It is a method that has been known
by the public
- Can be used in a long time
- Does not affect milk production
Implant - Once pairs for 5 years In most clients can cause changes in
- No effect on milk production menstrual patterns in the form of spotting,
- No affect blood pressure hipermenorea, or increase the amount of
- Good for women who do not want menstrual blood, and amenorrhoea.
any more children,
but has not well for tubektomi.
IUD/AKDR - Uninterrupted with forgetting factor ---
- long-term method (up to 10 years of
protection by using a Copper T 380A)
19
- Reducing visit to the clinic
- More cheap of the pill in the long term

MOP - Very effective - Permanent, can not return to normal

- Do not disturb for coitus interruptus fertility
- No change in sexual function - Effect delayed up to 3 months or 20
- Good for client if pregnancy would times ejaculations
make danger for her soul - Pain after the procedure and other
- Cheap complications resulting from surgery
and anesthesia
- Can only be done by a trained doctor
- No protection against PMS
MOW - Very effective - Permanent
- Permanent - Pain after the procedure and other
- Do not disturb when coitus complications resulting from surgery
interruptus and anesthesia
 - Good for client if pregnancy would - Can only be done by a trained doctor
make danger for her soul - No protection against PMS
- Surgery is simple and only need local - Increasing the risk of pregnancy
anesthesia ektokpik
- There are no long term side effects
- No sexual disorders

sumber : Kusumaningrum Radita.2009.Faktor-faktor yang Mempengaruhi Pemilihan Jenis Kontrasepsi yang

Digunakan Pada Usia Subur.Semarang:FK Undip

4. When the contraception after miscarriage begin?

Answer :
 Right now  ovulation can begin after 11 day, minimal patient understand the pregnancy
 Patienat hrs tau inidkasi dak kontraindikasi
 Pelayanan kesehatan hrs memberi tahu dimana bisa mendapatkan kontrasepsi
 Jika infeksi  hrs menunggu setelah infeksi sembuh
 Injection : we can use after miscarriage surgery imediatelly, or 30 day after miscarriage surgery
 IUD/AKDR can use after contraception if no infection, jk keguguran di trimester 1 bisa lgsg
digunakan, trimester 2 can use 4-6weeks after miscarriage

5. What is the best contraception of miscarriage?

Answer :
If the mom miscarriage in trimester 1 (yg digunakan sm dgn masa interval), trimester 2 (pakai sprti yg
pasca persalinan, ada yg menyusui dan tdk menyusui)

 MENYUSUI : Bias pake MAL utk 6 bulan, AKDR lbh dr 3 mggu, steril 6 minggu, progestin lbh dr 6
minggu,
 TDK MENYUSUI : AKDR 3 minggu, condom/spermasid after miscarriage dst.
 MOM WITH INFECTION : don’t use until infection clear, sblm 3 bulan bsa pake kombinasi,
 MOM WITH ABORTION SIGN : hrs menunggu 3 bulan sambil menunggu bisa pake progestin,
 INFECTION TDK BISA DIATASI : bias pake barrier/spermasidal

6. How the method of using contraception based on age after partus, and miscarriage?
Jawab :
a. IUD
 Patient can use IUD anytime in the menstrual cycle and make sure not pregnant
 Menstruation started 7 days ago, so IUD can installed
 After birth in the first 48 hours after birth or 4 weeks postpartum, between 48 hours to 4
weeks postpartum delayed installed, using condom contraceptive methods or MAL methods
 IUD can be installed after miscarriage within the last seven days, can be installed if there is
no infection, consolate with Doctor, Midwife, Village Midwife
 If infection occurs, may be can installed 3 months after recovery
b. Injection Contraseptive
  If you get menstruation up to 7 days ago or more than 7 days do not need to wait for the next
menstruation to get the first injection if sure not pregnant, candidates need to avoid
intercourse or use condoms for 7 days from the first injection.
 After birth if breastfeeding can start 6 weeks after partum, if the candidate is more than 6
weeks and less than 6 months, full breastfeeding and still not menstruated (Amenore
Lactation Method), may be injected at any time, but if breastfeeding is not full you should start
6 Weeks after childbirth, waiting more long time make risk be pregnant.
c. Pills
 Anytime as long as you are sure you are not pregnant, or getting your menstruation 5 days
ago can begin
 After partum, if breastfeeding can begin after the baby is 6 months old. If not yet menstruating
and make sure not being pregnant, the candidate KB pills should avoid intercourse or use a
condom 7 days first take the pill, if baby age less than 6 months wear condoms for a while.
 After partum, if not breastfeeding can begin 3 weeks after partum and certainly not pregnant,
if more than 4 weeks of candidates should avoid intercourse or use of condoms during the
first 7 days of taking the pill if not yet menstruating.
d. Implant
 Anytime as long as sure not pregnant, or get menstruation up to 7 days, if menstruation more
than 7 days ago, no need to wait for the next menstruation period by ensuring the candidates
are not pregnant
 After partum, if breastfeeding can begin after the baby is 6 months old. If not yet menstruated
and certainly not pregnant
 After partum, if not breastfeeding can begin, 6 weeks after partum can be started if it is not
pregnant should avoid intercourse or use condoms for 7 days after the installation of AKBK.
e. MOW
- It is surgery and the uterus is not removed and the mother still can menstruate, the method is
not easily restored to the original.
- The surgical action may be performed at any time except between 7 days to 6 weeks after
partum, safe before 7 days postpartum if the decision has been made before.
f. MOW
Anytime. But only effective after 20 times ejaculation or 3 months post operatively. Before that still
have to use condoms.

Sumber : BKKBN. 2011. Buku Panduan Praktis Pelayanan Kontrasepsi . PT Bina Pustaka Sarwono
Prawirohardjo: Jakarta

7. How the method of konseling contraception?

Jawab :
In counseling held 2-way conversation to:
 Discuss with the patients the various contraceptive options available
 Provide as comprehensive information about the consequences of choice, both of medical and
non-medical
 Helping the patient to decide the best method and suits their personality and her family
 Helping the patient to adjust their self to their new condition

The information provided includes:

 - Meaning of KB
- Family planning benefits
- Method of contraception / contraception method
- Rumors about contraception & explanation
- Family planning patterns & use rational contraception
- Referral of contraceptive services

Sumber : Hartanto, Hanafi. 2003. KB dan Kontrasepsi. Jakarta: Pustaka Sinar Harapan

8. What the side effect of the contaseptive?

Jawab :
a. IUD
 Cramps or abdominal pain may occur a few days after long periods of reduced installation
 There are spots within a few weeks
 A lot of Menstruation and more longer
 Spots (flek) between menstrual periods
 There is cramping or pain during menstruation
b. Injection
Side effects of Cyclofem injections that are often found are nausea, increased weight, headache,
dizziness and sometimes the symptoms disappear after a few months or after the injection is
stopped. The side effects of injections of Depo Provera, Progestin Depo, Geston and Noristeat
Depo are often found to be irregular menstruation, the period will be more long, bleeding spots
may even become anemic in some clients.
c. Pills
Using pills in some women can cause side effects, such as nausea, weight gain, headache (dizzy)
skin discoloration and these side effects can occur for months.
d. Implant
Sometimes at the time of installation will be painful. Also found irregular menstruation, headache,
occasionally spotting or anemia due to chronic hemorrhage.
e. Kontap
Rare, mild, and temporary eg swelling, pain, and infection of the wound. In vasectomy infection
and epididymitis occurs in 1-2% of patients. In tubectomy bleeding, infection, damage to other
organs and complications due to anesthesia may occur.
sumber : Kusumaningrum Radita.2009.Faktor-faktor yang Mempengaruhi Pemilihan Jenis
Kontrasepsi yang Digunakan Pada Usia Subur.Semarang:FK Undip
9. What is the hormonal physiology of the patient ? does it correlation with the prevered of the
contraception method
10. What are the inhibitor from using contraception?
Jawab :
a. Low knowledge of family planning program
b. Limited contraceptives used by men
c. The existence of side effects or health problems due to the use of contraception itself.
d. Factor culture "many children much fortune"

Resolution:
a. Basic strategy: from the structural must be established first.
  Reinforce the program in the area
 Ensure program sustainability
b. Operational strategy: which will be plunged into the community.
 Increased capacity of KB program service system
 Increase quality of program priorities.
 commitment in stabilization.
 Regulatory and support.
 Monitoring, evaluation and accountability of community services.
Sumber : BKKBN.1999. Kependudukan KB dan KIA.Bandung Balai Litbang
11. What are indication for contraception use?
Jawab :
 IUD
- Reproductive age
- The nulliparous state
- Allow long-term contraception
- Breastfeeding mothers who want contraception
- After delivery and not breastfeeding the baby
- After experiencing Abortus
- Low risk of PMS
- Do not want the hormonal method
- Do not like taking pills every day.
- Do not want pregnancy after 1-5 days of intercourse

Sumber : DepKes RI. 1993. Asuhan Kebidanan Pada Ibu Hamil Dalam Konteks Keluarga. Jakarta :
Pusat Pendidikan Tenaga Kesehatan DEPKES RI.
12. What the syariah rules of contraception?
Jawab :
 Hadits KB
Indeed it is better for you to leave your master in a state of sufficiency than to leave them a
burden to the people.((Hadits riwayat Al-Bukhari dan Muslim dari Saad bin Abi Waqqash ra)
 The decision of the big conference of the first board of Syuriah Nahdlatul Ulama to 1 in Jakarta as
follows:
If by 'azl (removing semen outside the uterus) or with a device that prevents the arrival of semen
into the uterus such as kopacis / condom, then the law makruh. Likewise makruh law if by taking
 drugs to exclude pregnancy. But if with something that decides pregnancy at all, then the law is
haram, except there is danger. For example, because too much childbirth in the opinion of
someone who is expert about this can make danger, then the law may be in any way what exists.
 Sterilisasi  When the husband and wife in a very forced condition (emergency), such as to
avoid the decrease of illness from father / mother to child offspring. What will be born, or
threatened the soul of the mother when she conceived or gave birth to a baby, then sterilization is
allowed by Islam.
 IUD
- The use of IUDs and the like can not be justified, as long as there are medicines and another
devices, because for its installing or controlling must be done by looking at the aurot of
women, it is forbidden in Islamic sariat, except in the urgent condition
- Then the national scholar's consultation on population, health and development decides,
among other things, "the use of intrauterine contraceptives (IUDs) in the implementation of
family planning can be justified if the installation and control is performed by medical
personnel or medical women, or if it can also be done by medical personnel Men
accompanied by other husbands or women.
Sumber : Fide H. Isngadi, Penjelasan keputusan musyawarah ulama terbatas mengenai keluarga berencana ,
(Malang: inspeksi penerangan Kandepag, 1973), hlm. 19-24.