Rural-Urban Women’s Decision-Making Autonomy on Contraceptive Use in Indonesia
Article Sidebar
Main Article Content
Abstract
This study examined the relationship between women’s decision-making autonomy and contraceptive use in Indonesia, using data from the 2014 Indonesia Family Life Survey (IFLS) on 9,153 married women aged 15–49. Ordered logistic regression was used to assess the relationship between women’s participation in four household decisions and their decision-making autonomy. These decisions include food purchases, household purchases, freedom to visit family and relatives, and contraceptive use. The findings indicate that women in urban areas have higher levels of decision-making autonomy than those in rural areas. The autonomy index generally increases with age, but rural women consistently show lower autonomy levels across all age groups compared to their urban counterparts. A positive relationship between decision-making autonomy and contraceptive use was observed in both rural and urban settings. The marginal effect of autonomy on contraceptive use is more pronounced for short-acting reversible contraception (SARC) than for long-acting reversible contraception (LARC). Behavioral economic factors, such as distorted perceptions of excessive risk information about LARC, upfront costs, potential discomfort, and traditional social norms, influence contraceptive attitudes and behaviors. These findings underscore the importance of addressing gendered power dynamics and societal norms that restrict women’s autonomy.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
• Agresti, A. (2010). Analysis of ordinal categorical data (2nd ed.). John Wiley & Sons, Inc.
• Amraeni, Y., Kamso, S., Prasetyo, S. B., & Nirwan, M. (2021). A matriarchal and patriarchal perception on women's autonomy in decision making on contraception: Qualitative analysis in Indonesia. Malaysian Journal of Medicine and Health Sciences, 17(SUPP12), 17–21. https://medic.upm.edu.my/upload/dokumen/2021122908090804_MJMHS_0776.pdf
• Belachew, T. B., Negash, W. D., Bitew, D. A., & Asmamaw, D. B. (2023). Prevalence of married women's decision-making autonomy on contraceptive use and its associated factors in high fertility regions of Ethiopia: A multilevel analysis using EDHS 2016 data. BMC Public Health, 23(1), Article 83. https://doi.org/10.1186/s12889-023-15009-y
• Chelva, M., Chard, S., Eberle, A., Lucchese, A., Kaushal, S., West, N., Marandu, P. D., Smith, G., Erwin, E., Tillya, R. P., Nswilla, A., & Yeates, K. (2022). Many women use contraceptives in secret: A qualitative study of health provider perspectives regarding barriers and enablers to reproductive health and antenatal care services in rural Tanzania. Journal of Global Health Reports, 6, Article e2022018. https://doi.org/10.29392/001c.33808
• Colbourn, T., Lewycka, S., Nambiar, B., Anwar, I., Phoya, A., & Mhango, C. (2013). Maternal mortality in Malawi, 1977-2012. BMJ Open, 3(12), Article e004150. https://doi.org/10.1136/bmjopen-2013-004150
• Dingeta, T., Oljira, L., Worku, A., & Berhane, Y. (2019). Unmet need for contraception among young married women in Eastern Ethiopia. Open Access Journal of Contraception, 10, 89–101. https://doi.org/10.2147/oajc.s227260
• Fischhoff, B., & Eggers, S. L. (2013). Questions of competence: The duty to inform and the limits to choice. In E. Shafir (Ed.), The behavioral foundations of public policy (pp. 219–230). Princeton University Press.
• Forty, J., Navaneetham, K., & Letamo, G. (2022). Determinants of fertility in Malawi: Does women autonomy dimension matter? BMC Women's Health, 22(1), Article 342. https://doi.org/10.1186/s12905-022-01926-4
• Gafar, A., Suza, D. E., Efendi, F., Pramono, A. P., Susanti, I. A., & Mishbahatul, E. (2020). Determinants of contraceptive use among married women in Indonesia. F1000Research, 6(April), Article 193. https://doi.org/10.12688/f1000research.22482.1
• Garnett, C., Pollack, L., Rodriguez, F., Renteria, R., Puffer, M., & Tebb, K. P. (2021). The association between nonbarrier contraceptive use and condom use among sexually active Latina adolescents. Journal of Adolescent Health, 68(5), 985–990. https://doi.org/10.1016/j.jadohealth.2020.07.044
• Gayatri, M. (2023). Determinants of contraceptive use in rural poor areas: Evidence from Indonesia. Indonesian Journal of Public Health, 18(1), 34–46. https://doi.org/10.20473/ijph.v18i1.2023.34-46
• Grunloh, D. S., Casner, T., Secura, G. M., Peipert, J. F., & Madden, T. (2013). Characteristics associated with discontinuation of long-acting reversible contraception within the first 6 months of use. Obstetrics and Gynecology, 122(6), 1214–1221. https://doi.org/10.1097/01.AOG.0000435452.86108.59
• Hameed, W., Azmat, S. K., Ali, M., Sheikh, M. I., Abbas, G., Temmerman, M., & Avan, B. I. (2014). Women's empowerment and contraceptive use: The role of independent versus couples' decision-making, from a lower middle income country perspective. PLOS ONE, 9(8), Article e104633. https://doi.org/10.1371/journal.pone.0104633
• Harpham, T., Tetui, M., Smith, R., Okwaro, F., Biney, A., Helzner, J., Duminy, J., Parnell, S., & Ganle, J. (2022). Urban family planning in Sub-Saharan Africa: An illustration of the cross-sectoral challenges of urban health. Journal of Urban Health, 99(6), 1044–1053. https://doi.org/10.1007/s11524-022-00649-z
• Hawkes, S., Allotey, P., Elhadj, A. S., Clark, J., & Horton, R. (2020). The lancet commission on gender and global health. The Lancet, 396(10250), 521–522. https://doi.org/10.1016/S0140-6736(20)31547-6
• Heil, S. H., Hand, D. J., Sigmon, S. C., Badger, G. J., Meyer, M. C., & Higgins, S. T. (2016). Using behavioral economic theory to increase use of effective contraceptives among opioid-maintained women at risk of unintended pregnancy. Preventive Medicine, 92, 62–67. https://doi.org/10.1016/j.ypmed.2016.06.023
• Hopkins, K., Yarger, J., Rossetto, I., Sanchez, A., Brown, E., Elmes, S., Mantaro, T., White, K., & Harper, C. C. (2023). Use of preferred contraceptive method among young adults in Texas and California: A comparison by state and insurance coverage. PLOS ONE, 18, Articles e0290726. https://doi.org/10.1371/journal.pone.0290726
• Htay, Z. W., Kiriya, J., Sakamoto, J. L., & Jimba, M. (2024). Association between women's empowerment and unmet family planning needs in low- and middle-income countries in Southeast Asia: A cross-sectional study. Women's Reproductive Health, 11(1), 17–32. https://doi.org/10.1080/23293691.2023.2174822
• Idris, I. B., Hamis, A. A., Bukhori, A. B. M., Hoong, D. C. C., Yusop, H., Shaharuddin, M. A. A., Fauzi, N. A. F. A., & Kandayah, T. (2023). Women's autonomy in healthcare decision making: A systematic review. BMC Women's Health, 23(1), Article 643. https://doi.org/10.1186/s12905-023-02792-4
• Kabir, R., Alradie-Mohamed, A., Ferdous, N., Vinnakota, D., Arafat, S. M. Y., & Mahmud, I. (2022). Exploring women's decision-making power and HIV/AIDS prevention practices in South Africa. International Journal of Environmental Research and Public Health, 19(24), Article 16626. https://doi.org/10.3390/ijerph192416626
• Lahiri, S., Bingenheimer, J., Sedlander, E., Munar, W., & Rimal, R. (2023). The role of social norms on adolescent family planning in rural Kilifi County, Kenya. PLOS ONE, 18(2), Article e0275824. https://doi.org/10.1371/journal.pone.0275824
• Laksono, A. D., Wulandari, R. D., Rohmah, N., & Matahari, R. (2023). Unmarried women and unintended pregnancy: An Indonesian cross-sectional study. Indian Journal of Community Medicine, 48(2), 361–363. https://doi.org/10.4103/ijcm.IJCM
• Lerch, M. (2019). Fertility decline in urban and rural areas of developing countries. Population and Development Review, 45(2), 301–320. https://doi.org/10.1111/padr.12220
• Maharani, A., Sujarwoto, S., & Ekoriano, M. (2023). Health insurance and contraceptive use, Indonesian Family Planning Census 2021. Bulletin of the World Health Organization, 101(8), 513–521. https://doi.org/10.2471/BLT.22.289438
• Mahendra, I. G. A. A., Wilopo, S. A., & Putra, I. G. N. E. (2019). The role of decision-making pattern on the use of long-acting and permanent contraceptive methods among married women in Indonesia. The European Journal of Contraception & Reproductive Health Care, 24(6), 480–486. https://doi.org/10.1080/13625187.2019.1670345
• Mare, K. U., Aychiluhm, S. B., Tadesse, A. W., & Abdu, M. (2022). Married women's decision-making autonomy on contraceptive use and its associated factors in Ethiopia: A multilevel analysis of 2016 demographic and health Survey. SAGE Open Medicine, 10, 1–14. https://doi.org/10.1177/20503121211068719
• McKenna, K., Arcara, J., Rademacher, K. H., Mackenzie, C., Ngabo, F., Munyambanza, E., Wesson, J., & Tolley, E. E. (2014). Policy and programmatic considerations for introducing a longer-acting injectable contraceptive: Perspectives of stakeholders from Kenya and Rwanda. Global Health: Science and Practice, 2(4), 459–471. https://doi.org/10.9745/GHSP-D-14-00106
• Nadeem, M., Malik, M. I., Anwar, M., & Khurram, S. (2021). Women decision making autonomy as a facilitating factor for contraceptive use for family planning in Pakistan. Social Indicators Research, 156(1), 71–89. https://doi.org/10.1007/s11205-021-02633-7
• Naibaho, M. M. P., Fajarningtiyas, D. N., Arifa, R. F., & Pancanugraha, A. (2022). Women's autonomy and unintended pregnancy: An IDHS 2017 data analysis. Jurnal Biometrika Dan Kependudukan (Journal of Biometrics and Population), 11(2), 145–155. https://doi.org/10.20473/jbk.v11i02.2022.145-155
• Nussbaum, M. C. (2000). Women and human development: The capabilities approach. Cambridge University Press.
• Onarheim, K. H., Iversen, J. H., & Bloom, D. E. (2016). Economic benefits of investing in women's health: A systematic review. PLOS ONE, 11(3), Article e0150120. https://doi.org/10.1371/journal.pone.0150120
• Ouahid, H., Mansouri, A., Sebbani, M., Nouari, N., Khachay, F. E., Cherkaoui, M., Amine, M., & Adarmouch, L. (2023). Gender norms and access to sexual and reproductive health services among women in the Marrakech-Safi Region of Morocco: A qualitative study. BMC Pregnancy and Childbirth, 23(1), Article 407. https://doi.org/10.1186/s12884-023-05724-0
• Poerwandari, E. K., Munti, R. B., & Viemilawati, J. (2018). Pro-women's policy advocacy movements in Indonesia: Struggles and reflections. Asian Journal of Women's Studies, 24(4), 489–509. https://doi.org/10.1080/12259276.2018.1538646
• Rohmah, N., Yusuf, A., Hargono, R., Laksono, A. D., Masruroh, Sujoso, A. D. P., Ibrahim, I., Marasabessy, N. B., Pakaya, N., Seran, A. A., Adriyani, R., & Walid, S. (2021). Barrier to contraceptive use among childbearing age women in rural Indonesia. Malaysian Family Physician, 16(3), 16–22. https://doi.org/10.51866/oa1020
• Senderowicz, L. (2020). Contraceptive autonomy: Conceptions and measurement of a novel family planning indicator. Studies in Family Planning, 51(2), 161–176. https://doi.org/10.1111/sifp.12114
• Singh, S., Darroch, J., Ashford, L., & Vlassof, M. (2009). Adding it up: The costs and benefits of investing in family planning and maternal and newborn health. Guttmacher Institute and United Nations Population Fund (UNFPA). https://www.guttmacher.org/sites/default/files/pdfs/pubs/AddingItUp2009.pdf
• Sserwanja, Q., Musaba, M. W., Mutisya, L. M., & Mukunya, D. (2022). Rural-urban correlates of modern contraceptives utilization among adolescents in Zambia: A national cross-sectional survey. BMC Women's Health, 22(1), Article 324. https://doi.org/10.1186/s12905-022-01914-8
• Stenberg, K., Axelson, H., Sheehan, P., Anderson, I., Gülmezoglu, A. M., Temmerman, M., Mason, E., Friedman, H. S., Bhutta, Z. A., Lawn, J. E., Sweeny, K., Tulloch, J., Hansen, P., Chopra, M., Gupta, A., Vogel, J. P., Ostergren, M., Rasmussen, B., Levin, C., … Bustreo, F. (2014). Advancing social and economic development by investing in women's and children's health: A new global investment framework. The Lancet, 383(9925), 1333–1354. https://doi.org/10.1016/S0140-6736(13)62231-X
• Stevens, J., & Berlan, E. D. (2014). Applying principles from behavioral economics to promote long-acting reversible contraceptive (LARC) methods. Perspectives on Sexual and Reproductive Health, 46(3), 165–170. https://doi.org/10.1363/46e0614
• Sully, E. A., Biddlecom, A., Darroch, J. E., Riley, T., Ashford, L. S., Lince-Deroche, N., Firestein, L., & Murro, R. (2020, July). Adding it up: Investing in sexual and reproductive health 2019. Guttmacher Institute. https://www.guttmacher.org/report/adding-it-up-investing-in-sexual-reproductive-health-2019
• Sunstein, C. R. (2013). If misfearing is the problem, is cost-benefit analysis the solution? In E. Shafir (Ed.), The behavioral foundations of public policy. Princeton University Press.
• Tareke, A. A., Takele, B. A., Ahmed, M. H., Tegegne, M. D., & Eshetu, H. B. (2023). Urban-rural inequalities and spatial arrangement of informed choice of family planning in Ethiopia: Further analysis of 2016 Ethiopian Demographic Health Survey. PLOS ONE, 18(8), Article e0289099. https://doi.org/10.1371/journal.pone.0289099
• Tesha, J., Fabian, A., Mkuwa, S., Misungwi, G., & Ngalesoni, F. (2023). The role of gender inequities in women's access to reproductive health services: A population-level study of Simiyu Region Tanzania. BMC Public Health, 23(1), Article 1111. https://doi.org/10.1186/s12889-023-15839-w
• United Nations. (September 2019). Family planning and the 2030 agenda for sustainable development (Data Booklet). https://doi.org/10.18356/e154e49d-en
• United Nations Development Programme (UNDP). (2023). The SDGs in action. United Nations Development Programme. Retrieved August 2024, from https://www.undp.org/sustainable-development-goals
• United Nations Population Fund (UNFPA). (2022a, March 30). Nearly half of all pregnancies are unintended—A global crisis, says new UNFPA report. https://www.unfpa.org/press/nearly-half-all-pregnancies-are-unintended-global-crisis-says-new-unfpa-report
• United Nations Population Fund (UNFPA). (2022b, March 30). State of world population 2022: Seeing the unseen: The case for action in the neglected crisis of unintended pregnancy. https://www.unfpa.org/sites/default/files/pub-pdf/EN_SWP22%20report_0.pdf
• United Nations Population Fund (UNFPA). (2022c, November). UNFPA strategy for family planning, 2022-2030: Expanding choices – Ensuring rights in a diverse and changing world. https://www.unfpa.org/publications/unfpa-strategy-family-planning-2022-2030
• UN Women. (2012, August). Policy brief: Decent work and women's economic empowerment. https://www.unwomen.org/en/digital-library/publications/2012/8/decent-work-and-women-s-economic-empowerment-good-policy-and-practice
• UN Women, & United Nations Department of Economic and Social Affairs. (2023, September). Progress on the Sustainable Development Goals: The gender snapshot 2023. UN Women. https://www.unwomen.org/sites/default/files/2023-09/progress-on-the-sustainable-development-goals-the-gender-snapshot-2023-en.pdf
• Wollum, A., Bornstein, M., Mopiwa, G., Norris, A., & Gipson, J. D. (2023). Assessing the relationship between reproductive autonomy and contraceptive use in rural Malawi. Reproductive Health, 20(1), Article 142. https://doi.org/10.1186/s12978-023-01688-8
• World Health Organization (WHO). (2023, September 5). Family planning/contraception methods. https://www.who.int/news-room/fact-sheets/detail/family-planning-contraception
• World Health Organization Department of Sexual and Reproductive Health and Research (WHO/SRH), & Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs (CCP). (2022, November 14). Family planning: A global handbook for providers (2022 update) (4th ed.). CCP and WHO. https://fphandbook.org/sites/default/files/WHO-JHU-FPHandbook-2022Ed-v221115a.pdf
• Wulandari, R. D., Laksono, A. D., & Matahari, R. (2021). The barrier to contraceptive use among multiparous women in Indonesia. Indian Journal of Community Medicine, 46(3), 479–483. https://doi.org/10.4103/ijcm.IJCM
• Yair, G. (2008). Insecurity, conformity and community: James Coleman's Latent Theoretical Model of Action. European Journal of Social Theory, 11(1), 51–70. https://doi.org/10.1177/1368431007085287