Kualitas Pelayanan menggunakan Indikator Method Information Index dan Keberlangsungan Penggunaan Kontrasepsi Modern Jangka Pendek: Studi Explanatory Sequential Mixed Methods

LASIAH SUSANTI, Prof. dr. Siswanto Agus Wilopo, SU., M.Sc., Sc.D.; Prof. dr. Adi Utarini, M. Sc, MPH, Ph. D

2026 | Disertasi | S3 Kedokteran Umum

Latar belakang: Tingkat putus pakai kontrasepsi di Indonesia masih relatif tinggi terutama pada pengguna kontrasepsi modern jangka pendek (pil, injeksi). Salah satu penyebabnya ialah rendahnya kualitas pelayanan keluarga berencana (KB), khususnya terkait dengan informasi yang didapat pengguna.

Tujuan: Penelitian ini bertujuan untuk menganalisis hubungan kualitas pelayanan dengan keberlangsungan penggunaan kontrasepsi modern jangka pendek melalui pendekatan kuantitatif dan kualitatif.

Metode: Penelitian dilakukan dalam dua tahap menggunakan explanatory sequential mixed methods. Tahap pertama kuantitatif menganalisis data sekunder dari Survei Demografi Kesehatan Indonesia (SDKI) 2017. Kualitas pelayanan diukur dengan method information index (MII), dianalisis bersama karakteristik demografi, sumber pelayanan, pemberi pelayanan, pengambil keputusan, dan metode pembayaran menggunakan survival analysis dan Cox proportional hazard. Tahap kedua kualitatif menggunakan data primer yang didapat melalui focus group discussion. Penelitian kualitatif dilakukan di Kota Pekanbaru dan Kabupaten Purworejo yang dipilih secara purposif untuk merepresentasikan variasi karakteristik pengguna kontrasepsi terkait dengan putus pakai kontrasepsi. Hasil analisis kuantitatif dan kualitatif diintegrasikan pada tahap interpretasi, dengan temuan kualitatif digunakan untuk menjelaskan dan memperdalam hasil kuantitatif.

Hasil: Tingkat putus pakai kontrasepsi modern jangka pendek mencapai 43,6%. Informed choice atau MII lengkap 30%, dan mengalami putus pakai lebih cepat. Mayoritas putus pakai melibatkan pengguna injeksi, tetapi pengguna pil mengalami putus pakai lebih dini. Efek samping merupakan alasan utama putus pakai. Determinan putus pakai meliputi informed choice, pengguna pil dan injeksi, switching methods, sumber pelayanan apotek, toko obat dan sejenisnya, kelompok usia <35>uninformed choice. Efek samping dirasakan pengguna metode pil dan injeksi yang kemudian berujung putus pakai atau switching methods.

Kesimpulan: Tingkat putus pakai kontrasepsi modern jangka pendek cukup tinggi dengan informed choice yang rendah. Keberlangsungan penggunaan kontrasepsi berkaitan erat dengan pengalaman efek samping. Perbaikan kualitas konseling keluarga berencana sangat diperlukan terutama terkait dengan antisipasi dan pengelolaan efek samping serta metode kontrasepsi alternatif, untuk mendukung keberlangsungan penggunaan kontrasepsi.

Background: The discontinuation rate of contraceptive use in Indonesia remains relatively high, particularly among users of short-acting modern contraceptive methods such as pills and injectables. One contributing factor is the suboptimal quality of family planning (FP) services, especially regarding the information provided to users. This study aims to analyze the relationship between FP service quality and the continuation of short-acting modern contraceptive use using both quantitative and qualitative approaches.

Methods: This study employed an explanatory sequential mixed-methods design. The first phase involved a quantitative analysis of data from the 2017 Indonesia Demographic and Health Survey (IDHS). Service quality was measured using the method information index (MII) and analyzed alongside demographic characteristics, service source, provider type, decision-making, and payment method using survival analysis and Cox proportional hazards models. The second phase involved a qualitative study using focus group discussions to further explore and explain the quantitative findings. The qualitative study was conducted in Pekanbaru City and Purworejo District, purposively selected to represent variation in contraceptive user characteristics, with quantitative and qualitative findings integrated at the interpretation stage to explain contraceptive discontinuation.

Results: The discontinuation rate of short-acting modern contraceptive methods was 43.6%, with side effects being the main reason for discontinuation. Injectable users accounted for the largest proportion of discontinuation episodes, while pill users discontinued earlier. Determinants of discontinuation included informed choice (MII), contraceptive method type, method switching, service sources such as pharmacies and drug stores, and age below 35 years. Qualitative findings showed that most participants experienced uninformed choice. Side effects were reported by all hormonal contraceptive users and frequently led to discontinuation or method switching.

Conclusion: The high rate of contraceptive discontinuation is closely related to inadequate quality of information and the experience of side effects. Continuation of contraceptive use is strongly influenced by the quality of counseling and users’ ability to understand and manage side effects. Strengthening family planning counseling, particularly regarding side effect management and alternative contraceptive options, is essential to improve contraceptive continuation in Indonesia.

Kata Kunci : informed choice, method information index, tingkat putus pakai, metode kontrasepsi jangka pendek, mixed methods research