Binomial Logistic Regression of Contraceptive Use among Indonesian Multiparous Women: Indonesia Health Survey 2023 Rea Ariyanti *1 .
Eka Putri Rahayu 2 .
Agustin Putri Rahayu 3 1,2,3 Public Health.
Faculty of Public Health.
University of Mulawarman reaariyanti@fkm.
ABSTRACT
Family planning (KB) is an important strategy to reduce maternal mortality by reducing the number of pregnancies and the proportion of high-risk pregnancies, while enabling family planning.
Although data from the Central Statistics Agency (BPS) shows fluctuations, the prevalence of active KB participation in Indonesia is not enough to significantly increase contraceptive use, especially in multiparous women.
The purpose of this study was to examine the factors that influence contraceptive use in Indonesian multiparous women.
This finding provides valuable insight for designing targeted family planning programs for multiparous women.
The study design was cross-sectional using secondary data obtained from the 2023 Indonesian Health Survey (SKI).
The analysis focused on data from 14,975 multiparous mothers who had filled out the questionnaire.
The dependent variable in this study was contraceptive use.
Independent variables included age, education level, occupation, insurance ownership, delivery method, pregnancy risk, and history of labor and postpartum complications.
Data were analyzed using binomial logistic regression.
The results of the study showed that determinant factors such as education level, occupation, delivery method, and history of delivery complications affected the use of contraceptives in multiparous women in general by only 3.
1%, while 96.
9% were influenced by other factors not included in this model test.
Targeted interventions are very important, including expanding contraceptive education for highly educated women and increasing flexible access to services for informal sector workers, as well as conducting counseling programs especially for women with a history of surgery or delivery with complications, to ensure optimal use of contraceptives.
Keywords : Binomial Logistic Regression.
Contraceptive Use.
Multiparous Women Published by:
Article history :
Tadulako University Received : 05 10 2025 Address:
Accepted : 19 12 2025 Jl.
Soekarno Hatta KM 9.
Kota Palu.
Sulawesi Tengah.
Indonesia.
licensed by Creative Commons Attribution-ShareAlike 4.
0 International License.
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PREVENTIF: JURNAL KESEHATAN MASYARAKAT VOLUME 16 NOMOR X
INTRODUCTION
Maternal mortality remains a significant global and regional challenge in reproductive health, with Indonesia's Maternal Mortality Rate (MMR) notably higher compared to many other ASEAN countries.
Globally, the situation is critical, with the United Nations International Children's Emergency Fund (UNICEF) reporting 712 daily maternal deaths from pregnancy-related complications, equating to one death every two minutes.
A key strategy to accelerate the reduction of these figures is the implementation of Family Planning (KB) programs.
The primary goal of these programs is to decrease maternal mortality by reducing the total number of pregnancies and lowering the proportion of highrisk pregnancies.
Furthermore.
KB helps couples plan family size, regulate birth spacing, and improve their overall quality of life.
Ae.
Despite its importance, the prevalence of active family planning participation in Indonesia has fluctuated over the last five years, per data from Badan Pusat Statistik (BPS), ranging from 55.
06% to 56.
Although the number of users has increased slightly, this trend has not been sufficient to significantly boost contraceptive use, particularly among multiparous women .
omen who have given birth more than onc.
This is a major concern, as multiparity is a proven adverse risk factor during pregnancy, labor, and the postpartum period.
Ae.
Studies, including one in Eastern Anatolia and another in Sidama State.
Ethiopia, consistently show that multiparous mothers are at a higher risk for serious complications, such as postpartum hemorrhage, antepartum hemorrhage, anemia, and malpresentation.
Therefore, for effective population control and to mitigate these obstetric risks, it is imperative for women desiring larger families to meticulously prioritize and utilize family planning and comprehensive antenatal care.
Ae.
The objective of this study is to examine the factors that influence contraceptive use among multiparous women in Indonesia.
The analysis will utilize a binomial logistic regression model to identify factors that contribute to contraceptive use.
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METHODS
This study is a secondary data analysis based on the 2023 Indonesian Health Survey (IHS) conducted by the Indonesian Ministry of Health.
The IHS employed a cross-sectional design and was conducted at the national level, encompassing households in 34 provinces, 416 districts, and 98 cities in Indonesia.
The analysis focused on data from 14.
multiparous mothers who completed the questionnaire.
The research instruments and data collection procedures were executed in accordance with the SKI 2023 standard protocol, employing structured questionnaires administered through interviews and physical measurements obtained by the SKI research team.
The dependent variable in this study was contraceptive use.
The independent variables encompassed age, categorized as 20-35 years old and age <20 or >35 years old.
education level, categorized as no school, primary, secondary, and higher education.
occupation, categorized as not working, working in the non-formal sector and formal sector.
insurance ownership, categorized as non-JKN and JKN.
delivery method, categorized as unassisted and assisted delivery.
risk in pregnancy, categorized as risk and no risk.
history of complications in childbirth and postpartum, categorized as history and no The analysis employed the binomial logistic regression method with a proportional odds model to assess the relationship between contraceptive use in multiparous women and its associated factors, including age, education, employment, insurance ownership, delivery method, pregnancy risk, history of complications in childbirth, and postpartum.
RESULTS
Based on univariate, bivariate and multivariate analysis, the following results were PREVENTIF: JURNAL KESEHATAN MASYARAKAT VOLUME 16 NOMOR X Table 1.
Bivariate Analysis of Determinant Factors on the Use of Contraceptive Devices in Multiparous Women in Indonesia Use of Contraceptives PCategory Yes Age 20-35 Tahuh <20 and >35 Tahun Education No Education 4 <0.
Primary Secondary Higher Maternal Occupation Not Working 7 <0.
Working in Non Formal Sector
Working in Sector Formal
Insurance Ownership
Non NHI
NHI
Delivery Method Unassisted Delivery Assisted Delivery Pregnancy Risks Yes History of Childbirth Complications Yes History of Postpartum Complicatios Yes Source: Secondary data from SKI .
Table 1 shows that there is a significant relationship between education level (Pvalue =0.
, maternal occupation (Pvalue =0.
, delivery method (Pvalue =0.
and history of complications in childbirth Pvalue =0.
with the use of contraceptives in multiparous PREVENTIF: JURNAL KESEHATAN MASYARAKAT VOLUME 16 NOMOR X women in Indonesia.
Meanwhile, reproductive age (Pvalue =0.
, employment status (Pvalue =0.
, health insurance ownership (Pvalue =0.
, risk factors in pregnancy (Pvalue =0.
, and history of complications during postpartum (Pvalue =0.
did not show a significant relationship with the use of contraceptives in multiparous women in Indonesia.
Table 2.
Final Modeling of Logistic Regression Analysis Results Variable Constant Age 20-35 Primary Education Secondary Education Higher Education Working in Non Formal Sector Working in Sector Formal Non NHI Insurance Ownership No Risks in Pregnancy Assisted Delivery Have Complications history of Childbirth Have Complications history of Postpartum Pvalue Exp(B) 1 <0.
1 <0.
1 <0.
CI 95%
Lower Upper Furthermore, other factors that have been shown to have a significant influence are higher education, assisted delivery, and respondent who have complicatons history of The findings of this study indicate that multiparous women with higher levels of education exhibit a 40.
6% lower risk compared to those who did not attend school (PR = 594, 95% CI .
Pvalue = 0.
Multiparous women employed in the formal sector exhibit a 18% reduced risk compared to mothers engaged in work within the informal sector (PR = 0.
820, 95% CI .
Pvalue = 0.
, women who gave birth with the assistance of health workers exhibited a 10.
9% higher probability of utilizing contraception compared to those who gave birth without such assistance (PR = 1.
109, 95%
CI .
Pvalue = 0.
, and multiparous women with a history of complications during childbirth exhibited a 10.
6% lower risk of using contraception compared to those PREVENTIF: JURNAL KESEHATAN MASYARAKAT VOLUME 16 NOMOR X without a history of complications during childbirth 0.
894, 95% CI .
Pvalue=0.
The binomial logistic regression equation with its threshold is as follows:
Logit (Y) = 1.
129X2 -0.
102X3-0.
Table 3.
Model Fit Test Goodness-of-Fit Nagelkerke R2 Chi-Square Sig.
Table 3 shows the results of the model fit test indicating that the model has a good fit with the data, based on the high chi-square (Pvalue = 0.
However, the low nagelkerke RA value .
1%) indicates that the model only explains a little of the variation in the data.
This means that determinant factors such as reproductive ages, education level, employment insurace ownership, risk in pregnancy, delivery method, history of complications in labor and postpartum affect the use of contraceptives in multiparous women in general by only 3.
1% while 96.
9% is influenced by other factors not included in this model test.
DISCUSSION
Maternal mortality in Indonesia remains a significant public health concern.
High rates of maternal mortality point to systemic issues with maternal and newborn health services, adversely impacting the physical, psychological, and social well-being and development of infants and toddlers.
The global burden of maternal mortality is predominantly attributable to complications arising from pregnancy, childbirth, and the postpartum period.
A multitude of studies have indicated that multiparous women are associated with an elevated risk of complications during pregnancy and childbirth.
Consequently, multiparous women are categorized as a high-risk group in clinical practice.
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Education level is frequently associated with contraceptive utilization.
A substantial body of research has demonstrated a robust correlation between the educational attainment of women and their utilization of contraceptive methods.
Specifically, findings have indicated that women with lower levels of education exhibit a lower propensity to employ contraceptive techniques in comparison to their more educated This suggests a positive correlation between higher educational attainment and increased rates of contraceptive use.
Contrary to the findings of previous studies, the results of this investigation suggest that the proportion of contraceptive use is higher among respondents who have not attended school compared to those with higher education.
This result may be inconsistent with broader research findings, and its implications may be explained by several factors.
For instance, this discrepancy may be attributable to variations in access to and availability of information regarding contraceptive methods.
Individuals with limited education levels are often the primary targets of health and family planning education in their respective Moreover, government initiatives have deliberately focused on providing free or subsidized contraceptive information and access to this demographic group, which may not be as comprehensive as that provided to the highly educated group, who are considered to have sufficient access to information.
This increased access is further bolstered by the implementation of JKN, a comprehensive national health insurance scheme designed to achieve universal health coverage (UHC).
A multitude of publications have indicated that JKN has been effective in reducing health disparities and significantly increasing access to services for its population, including family planning (KB) services.
Ae.
In addition to educational attainment, one's employment status exerts a significant influence on the utilization of contraceptive methods.
A previous employment status has been demonstrated to be associated with the use of contraceptives among women of reproductive age.
The utilization rate was found to be higher among employed women
PREVENTIF: JURNAL KESEHATAN MASYARAKAT VOLUME 16 NOMOR X
compared to their unemployed counterparts.
This phenomenon is partly attributable to the autonomy and decision-making capacity of employed women, as well as the potential for augmented financial independence and access to resources.
The findings of the study indicated that the proportion of contraceptive use was higher among respondents who were not employed compared to those who were employed in the formal sector.
This finding aligns with the results observed in Surabaya, which indicated that mothers engaged in formal sector employment exhibited reduced engagement in health education initiatives.
It has been demonstrated that respondents who are employed within the formal sector have restricted access to information regarding Conversely, respondents who are not employed may have greater availability to visit health facilities or participate in family planning counseling programs.
The flexibility in scheduling that these services offer, which is not bound by a strict formal work schedule, facilitates more convenient access to appointments, educational sessions, and contraceptive services.
Conversely, individuals engaged in formal sector employment may encounter constraints in terms of time, the complexity of obtaining authorization from their place of work, or elevated transportation expenses when attempting to access family planning services during their working hours.
This assertion is corroborated by research findings that indicate mothers who are not engaged in paid employment possess greater autonomy in terms of scheduling, enabling them to attend health facilities with greater frequency.
This is in contrast to mothers who are employed in formal or informal sectors, where constraints on their time and availability may hinder their ability to engage regularly with healthcare .
The present study found that complications in labor (Pvalue =0.
OR=0.
and surgical delivery (Pvalue=0.
OR=1.
were significantly associated with the use of contraceptives in multiparous women compared to normal or non-surgical delivery.
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study conducted at Panembahan Senopati Bantul Yogyakarta Hospital.
Indonesia, demonstrated that mothers who underwent cesarean sections were 1.
5 times more likely to utilize contraception compared to those who gave birth vaginally.
Operative childbirth is frequently linked to heightened pain intensity, an extended and more arduous recovery period, and an augmented likelihood of postpartum complications in comparison to vaginal delivery.
It is plausible that these traumatic or difficult experiences during childbirth motivate women to actively seek and use contraceptive methods to avoid future pregnancies.
This allows their bodies to fully recover and reduces the risk of difficult deliveries in the future.
Furthermore, health care professionals may adopt a more proactive stance in offering postpartum contraceptive counseling to women who undergo operative delivery, given the necessity for adequate pregnancy breaks to ensure optimal maternal and child health.
Consequently, these findings underscore the significance of the quality and experience of childbirth as crucial factors in the adoption of contraceptives among multiparous women, thereby emphasizing the necessity for comprehensive support for postpartum mothers.
CONCLUSIONS AND RECOMMENDATIONS
The present study revealed that education level, type of employment, mode of delivery, and history of complications during delivery have significant impacts on contraceptive use among multiparous women.
Consequently, targeted interventions are imperative, encompassing the expansion of contraceptive education for highly educated women and the augmentation of flexible access to services for informal sector workers.
Furthermore, the integration of postpartum Family Planning (FP) counseling programs is imperative, particularly for mothers with a history of surgical or complicated deliveries, to ensure the optimal use of contraceptives PREVENTIF: JURNAL KESEHATAN MASYARAKAT VOLUME 16 NOMOR X
BIBLIOGRAPHY