Contraceptive use dynamics in Indonesia with a special focus on Bali : measurements and determinants

Abstract

First, the study examines factors associated with the correlation between contraceptive prevalence and fertility rate. Second, it establishes measurements of contraceptive use dynamics (discontinuation, contraceptive failure, and switching) for the country as a whole with taking into consideration variation among provinces and its changes from 1986-91 to 1989-94. The analysis is then focused on Bali on the determinants of discontinuation and of switching behaviour of discontinuation. Because retrospective calendar data enable women to contribute more than one episode of use into the sample of analysis, episodes of use from the same woman may be correlated. Multi-stage sampling used in the DHS select individuals from the same cluster, where they are more likely to have similar attitude and behaviour in relation to contraceptive use. Therefore, multilevel discrete-time competing risks hazard models are used. Next, it analyses current modern contraceptive choice with a focus on the effect of price of contraception. As contraceptive choice and its price are interdependent, a system of simultaneous equations exists and two-stage estimation is used to deal with this problem.

The study also shows that contraceptive prevalence was only one of the factors associated with the total fertility rate. More importantly, about 30% of contraceptive users would discontinue within a year of initiation of use, with side effects of health concerns having an important role in discontinuation. Contraceptive failure was another important factor in fertility change, although the rate was generally low. In particular, the failure rate, as well as its overall discontinuation, increased in Bali. Even after being controlled for other variables Balinesse users were more likely to switch to another method than to abandon. Moreover, the probability of abandonment was low. The study of Bali shows that socio-economic and demographic factors were associated with discontinuation and switching behaviour. Furthermore, the change in price of contraception had a tendency to change the contraceptive mix, rather than to abandon the use of contraception. The users' behaviour in discontinuation and switching largely depended on individuals, and was unaffected by the behaviour of others in the community (cluster). Further studies should deal deeper with women's characteristics to investigate the remaining unexplained variation in contraceptive failure and other reasons for discontinuation as well as in switching to non-use while the users were at risk of an unintended pregnancy.

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