Pengaruh interaklsi bidan dengan klien dalam pengambilan keputusan kontrasepsi di Kabupaten Purworejo

BUNAS, Elfi Sumarni, dr. Siswanto A.W., Su, MSc, Sc.D

2008 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Pilihan metode kontrasepsi di Indonesia berbeda dengan di negara lainnya. Informasi yang benar tentang KB diperlukan sebagai dasar pengambilan keputusan kontrasepsi. Komunikasi suami-istri tentang KB mempengaruhi pengambilan keputusan kontrasepsi. Interaksi provider-klien dapat meningkatkan pengetahuan dan kemampuan klien dalam pengambilan keputusan kontrasepsi. Tujuan Penelitian: Penelitian ini bertujuan untuk menilai kualitas interaksi bidan dengan klien, pengaruh interaksi bidan dengan klien dalam pengambilan keputusan kontrasepsi serta komunikasi suami-istri tentang KB dalam pengambilan keputusan kontrasepsi. Metode Penelitian: Penelitian ini dilakukan dengan metode kualitatif, dengan subjek penelitian klien yang baru pertama kali mendapat pelayanan kontrasepsi dan bidan yang memberi pelayanan kontrasepsi. Cara pengambilan data melalui observasi, rekaman audio dan visual, wawancara mendalam dan wawancara terstruktur. Hasil dilaporkan dalam bentuk narasi. Hasil: Bidan tidak mengidentifikasi kondisi personal dan kebutuhan klien, sehingga dalam pengambilan keputusan kontrasepsi tidak rasional, efektif dan efisien. Interaksi bidan-klien dapat menambah pengetahuan klien, dan keputusan akhir dipilih setelah menerima informed choice dari bidan, sehingga klien sudah mengetahui segala konsekuensinya, karena klien sudah diberitahu berbagai pilihan, cara pakai dan juga kelebihan dan kekurangan berbagai alat kontrasepsi. Pengambilan keputusan KB umumnya dimusyawarahkan dengan suami, baik dalam hal jumlah anak, jarak antara kelahiran maupun penggunaan kontrasepsi. Kurangnya dorongan suami, mempengaruhi keputusan penggunaan kontrasepsi. Pengalaman orang-orang terdekat seperti: orangtua, saudara, teman maupun tetangga dan biaya mempengaruhi pengambilan keputusan kontrasepsi klien. Kesimpulan: Interaksi bidan-klien dapat mengubah keputusan klien yang sudah dimusyawarahkan antara suami-istri, tetapi keputusannya tidak rasional, efektif dan efisien, karena tidak mempertimbangkan persyaratan medis, tujuan penggunaan dan kondisi klien.

Background: The choice of contraceptive methods in Indonesia is generally different from that available in other countries in the world. Appropriate information on family planning is needed for contraceptive decision making. Couple or husband-wife communication influences the contraceptive method they will use. Furthermore, provider-client interaction can improve clients’ knowledge and ability in making a decision about a contraceptive method. Objective: This study aimed at assessing the quality of midwife-client interaction, the effect of midwife-client in contraceptive decision making, and husband-wife communication about contraceptive method in contraceptive decision making. Method: This was a qualitative study and the subjects were clients having the first contraceptive services and the midwives serving the clients. Data collection was carried out through observation, conversation recording, in-depth interview, and structured interview. Results are presented in a form of narration. Results: Midwife did not discuss clients’ health problems, delivery history, life situation, aims of family planning and desire to be pregnant again so that the decision making about contraceptive method was not based on rationale, effectiveness, and efficiency. Contraceptive decision making tended to be influenced by closed people’s experiences such as parents, sisters, friends and neighbors as well as contraceptive cost. Midwife-client interaction could likely improve clients’ knowledge and the final decision was made after midwife gave an informed choice to clients in a hope that they previously knew all consequences because they had already been told about various choices, procedure to use and the strengths and weaknesses of contraceptive methods. Husband-wife communication and support from husband were the encouragement to finally use a contraceptive method. This showed that husbandwife communication played an important role in acceptability and use of contraceptive methods. Conclusion: Midwife-client interaction could likely improve clients’ knowledge and the final decision on contraceptive methods was made after clients received an informed choice. However, this was not rationale, effective, and efficient because medical requirements, aims of contraceptive use and clients’ condition were not considered.

Kata Kunci : Interaksi bidan,klien,Pengambilan keputusan,Keluarga berencana,Komunikasi suami istri,Midwife-client interaction, decision-making, contraceptive method, husband-wife communication