Faktor-Faktor yang Mempengaruhi Praktek Pelayanan Pemasangan Kontrasepsi IUD oleh Bidan Praktek Swasta (BPS) di Kabupaten Demak Tahun 2012

Abstract

Universitas Diponegoro Fakultas Kesehatan Masyarakat Program Magister Ilmu Kesehatan Masyarakat Konsentrasi Administrasi dan Kebijakan Kesehatan Minat Manajemen Kesehatan Ibu dan Anak 2013 ABSTRAK Sri Wiji Faktor-Faktor yang Mempengaruhi Praktek Pelayanan Pemasangan Kontrasepsi IUD oleh Bidan Praktek Swasta (BPS) di Kabupaten Demak Tahun 2012 xiv + 135 halaman + 39 tabel + 4 grafik + 4 gambar + 12 lampiran Data AKI Kabupaten Demak masih tinggi, penyebab kematian adalah 4 terlalu. Sebenarnya AKI dapat dicegah dengan KB sesuai pilar Safe Motherhood yaitu dengan mempopulerkan metode KB jangka panjang seperti IUD. Cakupan kontrasepsi IUD di Kabupaten Demak tahun 2009-2011 hanya 3% dari jumlah PUS. Tujuan penelitian mengetahui faktor-faktor yang mempengaruhi praktek pemasangan kontrasepsi IUD oleh BPS di Kabupaten Demak. Penelitian ini menggunakan rancangan penelitian observational dengan pendekatan cross Sectional. Pengumpulan data dilakukan dengan wawancara dan observasi dengan kuesioner. Sampel dalam penelitian ini adalah BPS di Kabupaten Demak sebanyak 72 orang. Hasil uji analisa univariat menunjukkan bahwa semua responden sudah pelatihan, sebagian besar responden termasuk kategori baik dalam hal persediaan alat dan obat (77,8%), nilai sosial budaya (75,0%), pengetahuan (63,9%), kebijakan pemerintah (59,7%), sikap teman sejawat (56,9%), sikap (55%), sarana prasarana (54,2%), praktek (54,2%) dan supervisi pimpinan (52,8%). Namun masih ditemukan sarana yang kurang lengkap terutama meja ginekologi dan sterilisator. Yang masih jelek untuk praktek bidan belum menanyakan tujuan KB dan riwayat kesehatan, tidak menjelaskan proses pemasangan IUD serta tidak melakukan palpasi sebelum pemasangan. Hasil analisa bivariat menunjukkan bahwa ada hubungan antara faktor pelatihan, pengetahuan dan sikap terhadap praktek pemasangan kontrasepsi IUD. Hasil analisa multivariat menunjukkan faktor yang berpengaruh dengan praktek pemasangan kontrasepsi IUD adalah supervisi dan sikap p<0,05. Faktor yang pengaruhnya paling kuat dengan praktek pemasangan kontrasepsi IUD adalah supervisi dengan Exp (B) 5,079. Artinya responden yang sering dilakukan supervisi 5x lebih mungkin berpraktek baik dibandingkan yang supervisinya kurang. Saran meningkatkan pengetahuan bidan tentang efek samping dan efektifitas kontrasepsi IUD serta wajib menggunakan KB MKJP bagi paket Jampersal. Evaluasi pasca pelatihan karena masih banyak yang pengetahuannya kurang baik. Kata kunci : Kontrasepsi IUD, praktek pemasangan IUD, pelayanan kontrasepsi Diponegoro University Faculty of Public Health Master’s Program in Public Health Majoring in Health Policy Administration Sub Majoring in Maternal and Child Health Management 2013 ABSTRACT Sri Wiji Factors Affecting Practice of IUD contraception Insertion by Private Practice Midwives (BPS) in Demak District, 2012 xiv + 135 pages + 39 tables + 4 graphs + 4 figures + 12 enclosures Maternal mortality rates (AKI) in Demak district was still high. Causes of maternal death were four ‘too’ (terlalu). Maternal death could be prevented by KB according to the safe motherhood foundation: by popularizing long period KB method, such as IUD. Coverage of IUD contraception in Demak district in 2009-2011 was only 3% of PUS number. Objective of the study was to identify factors affecting practice of inserting IUD contraception by BPS in Demak district. This was an observational study with cross sectional approach. Data were collected through interview guided by questionnaire and observation. Study samples were 72 BPS in Demak district. Results of univariate analysis showed that all respondents had been trained, majority of respondents were good in providing instruments and medication (77.8%), social culture values (75.0%), knowledge (63.9%), government policy (59.7%), colleague attitude (56.9%), attitude (55%), facilities (54.2%), practice (54.2%), and leader supervision (52.8%). However, insufficient facilities were still found, such as gynecology tables and sterilization devices. Improper midwives practices found were midwives did not ask purpose of participating in KB and history of patient’s health; midwives did not explain IUD insertion procedure, and did not do palpation before insertion. Results of bivariate analysis showed an association between training, knowledge, attitude and practice of IUD contraception insertion. Results of multivariate analysis show that factors affecting practice of IUD contraception insertion were supervision and attitude (p< 0.05); supervision was the strongest factor affecting practice of IUD contraception insertion (Exp B= 5.079); it meant that respondents who were frequently supervised had 5 times to do better practice of inserting IUD contraception than respondents who were less frequently supervised. Suggestions given are to improve midwives knowledge about side effects and effectiveness of IUD contraception, to make KB MKJP for patients with Jampersal package compulsory, to do post training evaluation due to many respondents who did not understand after the training. Key words : IUD contraception, IUD insertion practice, contraception service