I Gusti Agung Agus Mahendra, Siswanto Agus Wilopo, Sukamdi, I Gusti Ngurah Edi Putra

The role of decision-making pattern on the use of long-acting and permanent contraceptive methods among married women in Indonesia

Objectives: 
This study aimed to analyse the association between the decision-making pattern and the use of long-acting and permanent methods of contraception (LAPMs) among married and cohabiting women in Indonesia, by controlling for variables at the individual and community or regional level, and geographical area (province).

Methods: 
A cross-sectional survey was conducted using secondary data from Performance Monitoring and Accountability 2020 (PMA2020) which involved 4724 married or cohabitating women aged 15–49 years. Data were analysed using bivariate and multivariate analysis. Multilevel logistic regression was performed to investigate the determinants by taking geographical area into account.

Results: 
The majority of women (63.8%) had made their own decision on current contraceptive use, 30.1% had made a joint decision with their partner or health care provider, and 6.1% had not been involved in the decision-making process. Multilevel analysis showed that the decision-making pattern and individual level factors were significantly associated with LAPM use, and variables at community or regional level were not significant predictors. Compared with women who had made their own decision on contraceptive use, LAPM use was 2.3 times higher in women who had made a joint decision with their partner or health care provider (odds ratio [OR] 2.3; 95% confidence interval [CI] 2.0, 2.7; p < .001) and more than three times higher in women not involved in the decision-making process (OR 3.1; 95% CI 2.3, 4.1; p < .001).

Conclusion: 
Coercion potentially occurs in the contraceptive decision-making process. Our findings suggest that LAPM use may be increased by encouraging joint contraceptive decision making. Increasing women’s participation in the decision-making process is an integral part of respecting women’s reproductive autonomy.