Abstract
Fertility is a contributor to the number of figures in the increase in population. The husband has a big role in the fertility process of his wife. The purpose of this study was to examine the relationship between the incidence of women of childbearing age fertility with husband support and the level of husband education in NTT Province. The design used in this study was cross-sectional. The data used is secondary data, which is sourced from the documentation of 2017 Indonesian Demographic and Health Survey (IDHS). The population of this study was all women of childbearing age in NTT Province in 2017, namely 2,223 women, and the sample used in this study was 323 women. Data analysis was carried out univariate and bivariate, using the Chi- Square Test. The results of the bivariate analysis were that there was no significant relationship between husband support and women of childbearing age fertility (pvalue= 0.219), and there was a significant relationship between the husband’s education level and women of childbearing age fertility (p-value=0.006).
Key words: Women of Childbearing Age
Introduction
Indonesia was declared by the Central Intelligence Agency (CIA) in The World Factbook, as the country ranked fourth in the world in the largest population. The calculation of the population is carried out by a population census every 10 years by the Statistics Indonesia (BPS). BPS noted an increase in the last 5 periods of the population census. The negative impacts caused by the increase in population are reduced availability of land and food, higher life competition rates, increased maternal mortality (MMR) rates, and also an increase in poverty, crime, and exploitation activities of minors such as the emergence of attitudes that can lead to early marriage.1-3 Population growth is caused by changes in the composition of the population, one of which is fertility.4 Fertility shows a significant association with population growth rate.5 The national fertility rate in 2017 showed a figure of 2.4 children/women of childbearing age.6 This figure shows a decrease from the figure obtained in 2021, which is 2.6 children/women of childbearing age. Almost all provinces in Indonesia experienced a decrease in the birth rate as well, but this is not the case with east Nusa Tenggara Province (NTT). In 2017, NTT Province became the largest rank holder with 3.4 children/women of childbearing age, in 2012 it showed 3.3 children/women of childbearing age, in 2007 it showed 4.2 children/women of childbearing age, in 2002 it showed 4.1 children/women of childbearing age, in 1997 it showed 3.45 children/women of childbearing age, and in 1994 it showed 3.87 children/women of childbearing age.7 These figures illustrate that the trend of the birth rate in NTT Province tends to fluctuate, with the numbers always far above the target. The government’s target for the national birth rate is 2.1 children/women of childbearing age.8 The government’s efforts to achieve this target are to create a family planning program.9
Community participation in the participation of the family planning program is still lacking.10 In NTT Province, this is marked by a high number of unmet needs for kb, namely 17.50% in 2012 and 17.60% in 2017. The target set by the government is only 7.4%.10 One of the birth control programs is carried out by using contraceptives, and this can affect the birth rate.11 The National Population and Family Planning Agency (BKKBN) stated that contraception can be used by both men and women, but it was recorded that in 2014 most users were only women (93.66%).12 Although dominated by women, the women of childbearing age coverage of contraceptive users continue to decrease, namely in 2016 by 44.6%, in 2017 to 43.84%, in 2018 to 43.37%, in 2019 to 43.03%, and in 2020 to 42.15%, while the government target was 63.41%.10 The use of contraceptives by women of childbearing age should not be separated from the participation of the spouse, that is, the husband. As a couple, the husband also holds the role of being the head of the family who has a role in making decisions in the household.13 Thus, support, as one of the reinforcing factors that can provide a warning to a person’s behavior, is needed by the wife.14 The form of husband support can be in the form of a pro-husband’s attitude towards the birth control program so that it will influence the wife to participate in the birth control program.15 The husband’s support will be even greater if the husband has a good education.16
Education belongs to one of the socioeconomic factors, capable of changing one’s mindset.17 A person who has the opportunity to get an education up to a higher level, will get more information about family planning, so that they will have the mindset to participate in the success of the family planning program. BPS states that education is one of the indicators in the assessment of the Human Development Index (HDI). Indonesia has launched a 12-year compulsory education program in several regions.18 However, in NTT Province in the National Socioeconomic Survey (SUSENAS) data, the average length of the male population aged 15 years and over in 2015 was 6.93 years, in 2016 it was 7.02 years, in 2017 it was 7.15 years, and in 2018 it was 7.3 years.18,19 So that the 12-year compulsory education program in NTT Province is still not well implemented.
Based on these things, a study was conducted that aimed to find out and examine the relationship between husband support and husband education level with women of childbearing age fertility in NTT Province in 2017.
Materials and Methods
This research is a quantitative study with a cross-sectional design that analyzed data from 2017 Indonesian Demographic and Health Survey (IDHS). The population in this study was 2,223 women of childbearing age in NTT Province which was recorded in the 2017 IDHS. Study participants were taken based on the inclusion criteria that had been determined by the researchers. Those inclusion criteria were women of childbearing age aged 15-49 years, women of childbearing age who are/have been married (including divorces alive/dead), women of childbearing age who live together/separately with a partner, women of childbearing age who have given birth alive (have one child alive when data is taken), women of childbearing age who use contraception, and there were no missing data on husband’s support and husband’s level of education. Thus, 323 women of childbearing age were obtained for this study in NTT Province. The instrument used in this study is a nontest instrument, which comes from the documentation of 2017 Indonesian Demographic and Health Survey (IDHS). The documentation was obtained from filling out the IDHS17-women of childbearing age Questionnaire conducted by the Statistics Indonesia (BPS). The questionnaire refers to Demographic Health Surveys (DHS) Phase 7, which contains the latest issues regarding international health. The analysis was carried out in a univariate way that described the frequency and percentage distribution of the respondent’s characteristics (age, education, working status, place of residence, and the use of health insurance), husband support, the husband’s level of education, and women of childbearing age fertility in NTT Province. Bivariate analysis with the Chi-Square test (X2) was used to examine the association between husband support and husband education level with women of childbearing age fertility.
Results
The characteristics of the respondents are an illustration of the diversity of conditions of the research sample described in Table 1.
Table 1 shows the characteristics of respondents in this study, namely as many as 323 women of childbearing age in NTT Province in 2017. The table illustrates that the majority of research respondents were in the age group of 30-34 years as many as 86 respondents (26.7%), completed elementary school education as many as 115 respondents (35.6%), had the status of workers as many as 180 respondents (55.7%), lived in rural areas as many as 242 respondents (74.9%), and health insurance users as many as 226 respondents (70%).
Table 2 shows the variables of husband support, husband education level, and women of childbearing age fertility in this study. Most women of childbearing age have husbands who support the implementation of family planning, namely as many as 282 respondents (87.3%), while as many as 41 respondents (12.7%) have husbands who do not support the implementation of family planning, a part of women of childbearing age has a husband who is poorly educated, namely as many as 170 respondents (52.6%), while as many as 153 respondents (47.4%) had highly educated husbands, and most women of childbearing age had ≤ 2 children, which was 168 respondents (52%), while as many as 155 respondents (48%) had > 2 children.
Table 1.
Univariate analysis of respondent’s characteristics.
| Characteristics of respondents | Total | |
|---|---|---|
| n | % | |
| Age | ||
| 15-19 | 5 | 1.5 |
| 20-24 | 45 | 13.9 |
| 25-29 | 80 | 24.8 |
| 30-34 | 86 | 26.6 |
| 35-39 | 71 | 22 |
| 40-44 | 28 | 8.7 |
| 45-49 | 8 | 2.5 |
| Education | ||
| Not Attending School | 9 | 2.8 |
| Elementary School | 115 | 35.6 |
| Junior High School | 63 | 19.5 |
| Senior High School | 75 | 23.2 |
| Academy/Diploma | 17 | 5.3 |
| Bachelor’s degree/University | 44 | 13.6 |
| Working Status | ||
| Work | 180 | 55.7 |
| Not Working | 143 | 44.3 |
| Residence | ||
| Rural | 242 | 74.9 |
| Urban | 81 | 25.1 |
| Health Insurance Users | ||
| Yes | 226 | 70 |
| No | 97 | 30 |
Table 2.
Distribution of study participants according to husband’s support, husband’s education level, and women of childbearing age fertility.
| Characteristics of respondents | Total | |
|---|---|---|
| n | % | |
| Husband Support | ||
| Yes | 282 | 87.3 |
| No | 41 | 12.7 |
| Husband’s Education Level | ||
| High | 153 | 47.4 |
| Low | 170 | 52.6 |
| Women of Childbearing Age Fertility | ||
| ≤ 2 children | 168 | 52 |
| > 2 children | 155 | 48 |
Table 3 shows there is no significant relationship between husband’s support and women of childbearing age fertility (pvalue >0.05). While the level of education of husbands has a significant association with women of childbearing age fertility (pvalue <0.05). Respondent whose husband has higher education has a 1.865 times greater risk of having ≤2 children than respondent whose husband with low education level (OR = 1.865; 95% CI 1.198 – 2.905).
Discussion
The results of the bivariate analysis that has been carried out in this study, show that the variable of husband support is not related to women of childbearing age fertility in NTT Province in 2017. The results of this study are not in line with several previous studies which stated that husband support, in the form of the husband’s opinion and consent regarding participation in birth control, namely the use of contraceptives, showed an influence on women of childbearing age fertility.15,20,21 If based on these studies, husbands who do not support the implementation of birth control are a risk factor for the high fertility rate. However, based on the OR value obtained in this study, which is <1, it means that the husband who supports the implementation of family planning is a protective factor for women of childbearing age who give birth to ≤ 2 children. The husband’s support included several types, namely emotional support, appreciation, instrumental, information, and social networks. Research conducted by Yoon showed that husband support can affect women of childbearing age fertility behavior, which is in the form of husband support provided through direct actions in doing housework and parenting.21 It explained that the husband’s support which can be related to women of childbearing age fertility is instrumental. In this study, researchers only focused on matters related to the implementation of family planning divided support according to their level and did not measure or compare support by type.
Differences in the results of this study with other studies can come from various things that also affect the variables of husband support. Korea is one of the countries that is famous for its very long working hours. This results in husbands there not having a hand in housework and all decisions at home.22 Decisions at home, both regarding family planning, and other matters need to involve the husband and need to be discussed properly by the husband and wife.23 However, many husbands still feel that they are not related to matters that refer to the birth control program and the responsibility lies entirely in the hands of the wife, and also the husband has the perception that there are other families, especially those of the female sex, who can help their wives.24 Thus, the support given to the wife is very lacking. In addition, the lack of support provided by the husband may be due to the wife’s low knowledge about the husband’s involvement in decision-making regarding birth control.25
A low-knowledgeable husband will also have a low interest in the birth control program. 26 This is common in rural areas. The exposure to information about the family planning program in rural areas is still quite low when compared to urban areas. Health services in rural areas are also still lacking and difficult to access, thus supporting the low knowledge of the people in the area regarding the family planning program. The support provided by the husband was still closely related to the existence of a gender gap so decision-making was entirely taken by the husband and can affect the number of children born. Related to gender issues that position husbands/spouses as power holders and decisions in the household, women of childbearing age in Bangladesh do the opposite, namely holding decisions and powers related to fertility arrangements, because what plays a big role in fertility is the women of childbearing age.27Women of childbearing age also have a greater risk in the process of pregnancy and childbirth. If women of childbearing age can have a good discussion about matters in the birth control program, and the husband is more able to appreciate the wife’s opinion, then most likely, fertility will be better controlled.28 In this study, half of the respondents’ data that matched the researcher’s criteria had to be excluded from the sample. This happens because of the discovery of missing data on respondents’ answers to several question items. So, it is likely to affect the results of statistical tests carried out on this variable.
This study also found that level of husband education was related to women of childbearing age fertility in NTT Province in 2017. It was in line with other research conducted in India and West Sumatra Province, which states that there is a relationship between the education that has been taken by the husband and fertility.28,29 Education is a supporter of changing one’s attitude. One of them is the occurrence of changes in a person’s attitude and behavior in their reproductive activities.30 The higher the education that has been taken; the more knowledge gained will also be. This is because education is also related to a person’s knowledge. Higher education allows a husband to have better knowledge and attitudes about birth control and reproductive health so that he can think critically about anything that must be prepared in advance to have children so that fertility in women decreases. 28,29
Government policies have usually been socialized through the existing education system in a country. Thus, if a person does not take part in the level of education, then his knowledge will be less than that who take up to the highest level of education. A person who focuses on higher education will usually postpone marriage, thus affecting future fertility. A husband’s high education can increase his involvement in birth control programs and reproductive health. This is due to the increase in the knowledge possessed by the husband as well. Thus, facilitating communication between husband and wife. The wife will have a discussion friend who is equally familiar with matters related to birth control, such as what methods will be used, what problems will be faced, and other decisions and the husband with adequate knowledge will be more enthusiastic about being involved in the birth control program. The husband’s high education, if followed by a high wife’s education as well, will have more influence on fertility. Women who pursue higher education will sometimes delay having children because they want to continue their education to a higher level which causes a low fertility rate.
Table 3.
Association between husband’s support and husband’s education level with women of childbearing age fertility.
| Variables | Women of childbearing age fertility | Odds ratio (95% CI) | P-value | |||
|---|---|---|---|---|---|---|
| ≤ 2 | > 2 | |||||
| n | % | n | % | |||
| Husband’s support | 0.658 (0.337 –1.286) | 0.219 | ||||
| Yes | 143 | 50.7 | 139 | 49.3 | ||
| No | 25 | 60.9 | 16 | 39.1 | ||
| Husband’s education level | 1.865 (1.198 – 2.905) | 0.006* | ||||
| High | 92 | 60.1 | 61 | 39.9 | ||
| Low | 76 | 44.7 | 94 | 55.3 | ||
Conclusions
This study found that there was a significant association between the husband’s education level variable and women of childbearing age fertility, but not for the husband support variable. The arrangement that can be conveyed by researchers to the government, especially BKKBN or the Health Office in NTT Province is an effort to increase public knowledge by holding Communication, Information, and Education (IEC) activities, both for women of childbearing age and their husbands. Thus, efforts to reduce the birth rate went smoothly because of the high cooperation between women of childbearing age and their husband
Acknowledgments
The authors would like to thank the DHS program which has allowed authors and provided data for this study.
References
- 1.Putri NC, Nurwati N. Pengaruh Laju Pertumbuhan Penduduk Berdampak pada Tingginya Angka Kemiskinan yang Menyebabkan Banyak Eksploitasi Anak di Indonesia. Iqtisaduna 2015;1(1):1–15. [Google Scholar]
- 2.Jumliadi M, Hendarso Y, Nengyanti. Research Gap dan Model Faktor yang Mempengaruhi Tingkat Fertilitas: Review Literatur. JPP (Jurnal Kesehat Poltekkes Palembang). 2020;15(1):52–60. [Google Scholar]
- 3.Alma LR, Dhian; K, Nurnaningsih Herya Ulfa. Analisis Pengetahuan Dan Sikap Siswa Sma Yang Berisiko Terjadinya Pernikahan Usia Dini. Prev Indones J Public Heal [Internet]. 2020;5(Vol 5, No 1 (2020)):49–54. Available from: http://journal2.um.ac.id/index.php/preventia/article/view/14783/6019 [Google Scholar]
- 4.Suartha N. Faktor-Faktor yang Mempengaruhi Tingginya Laju Pertumbuhan dan Implementasi Kebijakan Penduduk di Provinsi Bali. Piramida. 2016;12(1):1–7. [Google Scholar]
- 5.Ainy H, Nurrochmah S, Katmawanti S. Hubungan Antara Fertilitas, Mortalitas, Dan Migrasi Dengan Laju Pertumbuhan Penduduk. Prev Indones J Public Heal. 2019;4(1):15. [Google Scholar]
- 6.BKKBN BPS, Kemenkes USAID. Survei Demografi dan Kesehatan Indonesia 2017. September. 2018. 1–606 p. [Google Scholar]
- 7.Rahmadewi R, Asih L. Tingkat Fertilitas di Provinsi Nusa Tenggara Timur dan Yogyakarta. Kesmas Natl Public Heal J. 2011;6(3):117. [Google Scholar]
- 8.BKKBN. Rencana Strategis BKKBN 2020-2024. 2020. 1–71 p. [Google Scholar]
- 9.Kemenkes RI. Situasi dan Analisis Keluarga Berencana [Internet]. 2014. p. 1–8. Available from: https://www.kemkes.go.id/resources/download/pusdatin/infodatin/infodatin-harganas.pdf [Google Scholar]
- 10.Suryaningsih R. Analisis Pengaruh Faktor Sosial Ekonomi terhadap Tingginya Mortalitas Penduduk. Econ Dev Anal J. 2017;6(4):458–68. [Google Scholar]
- 11.Fitri A, Trisnaningsih Nani S. Hubungan Tingkat Pendidikan Penggunaan Kontrasepsi dengan Jumlah Anak yang Dilahirkan Wanita PUS. JPG (Jurnal Penelit Geogr. 2016;4(2):1–15. [Google Scholar]
- 12.BKKBN. Peraturan Kepala Badan Kependudukan dan Keluarga Berencana Nasional Nomor 24 Tahun 2017 Tentang Pelayanan Keluarga Berencana Pasca Persalinan dan Pasca Keguguran. In 2017. p. 1–64. Available from: https://jdih.bkkbn.go.id/public_assets/file/b46495c55893d8086a6fa2b5c2929af9.pdf [Google Scholar]
- 13.Septiwiyarsi. Analisis Faktor yang Mempengaruhi Pemilihan Kontrasepsi Metode Operatif Wanita (MOW) di Rumah Sakit Muhammadiyah Palembang Tahun 2016. Sci J. 2017; 6(2):170–81. [Google Scholar]
- 14.Suyati. Pengaruh Dukungan Suami Terhadap Ketepatan Kunjungan Ulang Akseptor KB Suntik. Str J Ilm Kesehat [Internet]. 2013;2(2):62–8. Available from: https://sjik.org/index.php/sjik/article/view/56 [Google Scholar]
- 15.Arsyad SS, Nurhayati S. Determinan Fertilitas Di Indonesia (Determinant of Fertility in Indonesia). Kependud Indones [Internet]. 2016;11(1):1–14. Available from: http://ejurnal.kependudukan.lipi.go.id/index.php/jki/article/ download/65/96 [Google Scholar]
- 16.Sulastri S, Nirmasari C. Hubungan Dukungan Suami dengan Minat Ibu dalam Pemakaian Kontrasepsi IUD di Bergas. Pros Semin Nas Int. 2014;2(2):44–9. [Google Scholar]
- 17.Siregar MI, Nasriah. Hubungan Tingkat Pendidikan Pasangan Usia Subur (15-49 Tahun) dengan Keberhasilan Program Keluarga Berencana. J Millenial Community. 2019;1(2):51–6. [Google Scholar]
- 18.Peraturan Menteri Pendidikan dan Kebudayaan RI. Peraturan Menteri Pendidikan dan Kebudayaan Republik Indonesia Nomor 80 Tahun 2013 Tentang Pendidikan Menengah Universal [Internet]. http://www.unesco.org/education/edurights/media/docs/5df9d1b1e9be0047ab26605574fe 561866e476c8.pdf; 2013. p. 7. Available from: http://kelembagaan.ristekdikti.go.id/wp-content/uploads/2016/11/permen_tahun2013_nomor80.pdf [Google Scholar]
- 19.BPS Provinsi NTT. Provinsi Nusa Tenggara Timur dalam Angka 2019. Statistik BIP dan D, editor. Badan Pusat Statistik Provinsi Nusa Tenggara Timur; 2019. 1–595 p. [Google Scholar]
- 20.Yoon SY. The Influence of A Supportive Environment for Families on Women’s Fertility Intentions and Behavior in South Korea. Demogr Res. 2017;36(1):227–54. [Google Scholar]
- 21.Keesara S, Juma PA, Harper CC, Newmann SJ. Barriers to Postpartum Contraception: Differences Among Women Based on Parity and Future Fertility Desires. Cult Heal Sex [Internet]. 2018;20(3):247–61. Available from: 10.1080/13691058.2017.1340669 [DOI] [PubMed] [Google Scholar]
- 22.Kim EHW. Division of Domestic labour and Lowest-Low Fertility in South Korea. Demogr Res. 2017;37(1):743–68. [Google Scholar]
- 23.Ndahindwa V, Kamanzi C, Semakula M, Abalikumwe F, Hedt-Gauthier B, Thomson DR. Determinants of Fertility in Rwanda in The Context of A Fertility Transition: A Secondary Analysis of The 2010 Demographic and Health Survey. Reprod Health. 2014;11(1):1–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Adelekan A, Omoregie P, Edoni E. Male Involvement in Family Planning: Challenges and Way Forward. Int J Popul Res. 2014;2014:1–9. [Google Scholar]
- 25.Story WT, Burgard SA, Lori JR, Taleb F, Ali NA, Hoque DE. Husband’s Involvement in Delivery Care Utilization in Rural Bangladesh: A Qualitative Study. BMC Pregnancy Childbirth. 2012;12(28):1–12. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Kiswanto Wardani HE, Hapsari A. Hubungan Pengetahuan dengan Mitra Pria dalam Keluarga Berencana di Desa Klampok, Kecamatan Singosari, Kabupaten Malang. Sport Sci Heal. 2019;1(1):10–3. [Google Scholar]
- 27.Rahman MM, Mostofa MG, Hoque MA. Women’s Household Decisionmaking Autonomy and Contraceptive Behavior among Bangladeshi Women. Sex Reprod Healthc [Internet]. 2014;5(1):9–15. Available from: 10.1016/j.srhc.2013.12.003 [DOI] [PubMed] [Google Scholar]
- 28.Mahanta A. Impact of Education on Fertility: Evidence from a Tribal Society in Assam, India. Hindawi Int J Popul Res. 2016;2016:1–7. [Google Scholar]
- 29.Larasati D, Idris Anis A. Terhadap Fertilitas Di Sumatera Barat. J Ecogen. 2018;1(3):648–58. [Google Scholar]
- 30.Muhoza DN, Broekhuis A, Hooimeijer P. Variations in Desired Family Size and Excess Fertility in East Africa. Int J Popul Res. 2014;2014:1–11. [Google Scholar]