Kekerasan suami terhadap istri masa hamil-nifas dan dampaknya bagi kesehatan reproduksi perempuan di dua desa Kabupaten Donggala Sulawesi Tengah

NUR, Rosmala, Promotor Prof. Dr. H. Muhadjir Darwin, MA

2010 | Disertasi | S3 Kependudukan

Penelitian ini bertujuan mengkaji bentuk kekerasan masa hamil–nifas, faktor penyebab dan dampaknya terhadap gangguan kesehatan reproduksi, kaitan antara faktor sosial demografi dan gangguan kesehatan reproduksi serta pola penanganannya. Penelitian dilakukan di Desa Sunju (perdesaan) dan Kelurahan Tanjung Batu (perkotaan) Kabupaten Donggala Sulawesi Tengah. Sampel penelitian ini adalah seluruh perempuan kawin usia subur yang sedang hamil, masa nifas, pernah mengalami hamil dan melahirkan maksimum 2 tahun lalu, dan mengalami kekerasan pada masa itu sebanyak 94 responden. Pengumpulan data dilakukan melalui wawancara terstruktur, wawancara mendalam, observasi partisipasi moderat, focus group discussion dan dokumentasi. Hasil penelitian menunjukkan bahwa kekerasan suami terhadap istri terjadi pada masa hamil–nifas, dan persentase terbanyak dialami istri di kota sebesar 43,28 persen daripada di desa sebanyak 42,8 persen. Bentuk kekerasan yang dialami istri pada masa itu adalah kekerasan fisik, psikologis, seksual dan ekonomi. Faktor penyebabnya bervariasi. Pada level kemasyarakatan yakni nilai-nilai budaya dan agama yang membolehkan laki-laki mengontrol perempuan serta kebijakan Negara belum berperspektif gender. Level komunitas adalah rendahnya status sosial ekonomi istri. Level mikro-keluarga yaitu uang perkawinan/doi’ balanca, poligami, kebutuhan dan keinginan suami tak-terpenuhi, kehamilan tak-diinginkan suami serta suami pengangguran. Pada level mikro-individual yaitu suami pengguna alkohol, hobbi pornografi dan berkarakter pemarah. Faktor paling dominan pada level-mikro di desa dan kota adalah kebutuhan dan keinginan suami tak-terpenuhi. Kekerasan masa hamil–nifas baik di desa maupun di kota berdampak pada gangguan kesehatan reproduksi istri, dari dampak tidak fatal sampai fatal. Dampak tidak fatal adalah komplikasi kehamilan, kehamilan tak-diinginkan, penyakit menular seksual, aborsi tidak aman, kelahiran prematur/bayi lahir berat rendah dan hilangnya gairah seksual, sementara dampak fatal antara lain kematian ibu dan kematian bayi. Perbedaan gangguan kesehatan reproduksi (komplikasi kehamilan) berkaitan dengan kondisi sosial-demografi istri. Hasil uji statistik memperlihatkan perbedaan dalam kelompok umur, tingkat pendidikan, jumlah anak masih hidup (AMH) yang dimiliki dan tempat tinggal desa-kota dengan komplikasi kehamilan. Namun, perbedaan gangguan kesehatan reproduksi (kehamilan tak-diinginkan) hanya terjadi dalam kelompok umur, tingkat pendidikan dan tempat tinggal. Respons istri terhadap gangguan kesehatan reproduksi bahwa di desa mereka umumnya pergi ke dukun anak, sementara di kota mereka mencari pelayanan ke bidan desa. Diam menjadi pilihan utama reaksi istri yang menjadi korban kekerasan. Namun bila kekerasan itu dianggap membahayakan kesehatan dan keselamatan jiwa, di desa mereka umumnya melaporkan kekerasan itu ke dewan adat Pabisara ada’, sementara di kota mereka memilih melawan atau menghindari daripada melapor. Pola penanganan perempuan korban kekerasan pada masa hamil melalui kearifan lokal Pabisara ada’ tersebut merupakan pilihan alternatif yang diinginkan oleh responden di kedua wilayah. Hal ini karena tempatnya dapat dijangkau perempuan, yaitu di desanya sendiri; perempuan tidak dibebani untuk membayar biaya perkara; dan waktu penyelesaian perkara lebih cepat (maksimal vii 24 jam) setelah masalah dilaporkan dan dewan adat Pabisara ada’ melakukan sidang serta menghasilkan keputusan. Temuan teoritis penelitian ini adalah pertama, terjadinya kekerasan suami terhadap istri pada masa hamil-nifas karena struktur dominatif—ketimpangan relasi suami terhadap istri yang terekspresi mulai dari level kemasyarakatan-individual. Kedua, kekerasan suami terhadap istri pada masa hamil-nifas berdampak pada kesehatan reproduksi yang berbeda-beda menurut kondisi sosial demografi istri saat itu.

This research aims to analyze the forms of violence during pregnancy and post-childbirth, the causes and impact on reproductive health, the link between social demographic factors and reproductive health disorders as well as the patterns of treatment. This research has been conducted in Sunju Village (rural) and Tanjung Batu Village (urban) Donggala regency, Central Celebes. The samples were all married women of childbearing age who are pregnant, women at post-childbirth, those who have experienced pregnancy and giving birth at maximum of two years ago, and experienced violence at that time. The respondents were 94 women. The data were collected through structured interviews, in-depth interviews, observation moderate participation, focus group discussions and documentation. The results showed that husband to wife violence occurred during pregnancy and post-childbirth. Higher experience of violence was suffered by women in urban area than those in the rural. The percentage of violence toward wife in the urban reached 43,28 percent, while that in the rural was 42,8 percent. The forms of violence suffered by the wife at the time were physical, psychological, sexual and economic. The contributing factors were varied. At the societal level, cultural values and religion that allows men to control women and the state policy that has not been using gendered perspective. At the community level, the low socio-economic status of the wives is another. At the micro-family level, the supporting factor could be marital money/doi 'balanca, polygamy, the unfulfilled husband’s needs, unwanted pregnancies and husband's unemployment. Whereas, at the micro-individual level, the husband addiction to alcohol, pornography and grumpy character would also trigger the violence. In fact, the most dominant factor at the micro-level in the urban and rural are the unfulfilled needs and desires of husband. Violence during pregnancy and post-childbirth both in urban and rural has an impact on wives reproductive health problems. The impact ranged from nonfatal to fatal. The non fatal impacts such as complication of pregnancy, unwanted pregnancy, sexually transmitted diseases, unsafe abortion, premature birth / low birth weight and loss of sexual desire, while the fatal effects include maternal mortality and infant mortality. Differences in reproductive health disorders (pregnancy complications) are often associated with the wives’ socio-demographic conditions. A statistical test results demonstrated a difference between the age group, education level, number of children still live (AMH), rural-urban residence and the pregnancy complications. However, differences in reproductive health disorders (unwanted pregnancy) occurred only in the age group, education level and place of residence. The response of wives to their reproductive health problems were differs. In the rural the women generally go to the traditional birth attendants (dukun bayi), while in urban they are looking for services to the village midwife. Silent became the main choice of wives who experience violence. But when violence became serious and endanger the health as well as their life, in the rural the women are generally reported it to the board of customs, Pabisara ada', whereas in the urban they chose to fight or avoid rather than reporting. Patterns of handling women victims of violence during pregnancy through local wisdom Pabisara ada’ is an alternative option chosen by the respondents in both regions. This is because the place could be easily reached by women, since it is still in their own village. Women are also not burdened to pay the legal costs, and faster case turn around time (maximum 24 hours) after problems were reported, the Pabisara ada’ council hold the hearing and make a decision. The Theoretical findings of this study is the first, husband to wife violence during pregnancy and post-childbirth caused dominative structure - inequal relation of husband to wife the expression ranged from societal-individual level. Second, husband to wife violence during the pregnancy and post-childbirth gives varied impact on the women reproductive health regarding the socio demographic conditions of the wives at the time.

Kata Kunci : Kekerasan,Kesehatan reproduksi,Pola penanganan,Violence, Reproductive Health, Treatment Patterns