The Factors Related to the Use of the IUD at Health Center of Batu-batu, Soppeng Regency in 2019

Currently, the problem that is being faced by the Indonesian state is the population problem. The IUD (Intrauterine Contraception) is a long-term contraceptive option, but most women prefer short-term contraception such as pills, injections and implants. This research is a descriptive survey with a cross sectional study design. The sample of this study were women of childbearing age who were married and used contraception in the working area of the Batu-Batu Health Center, Marioriawa District, Soppeng Regency from January to October 2019 and a total of 2017 people. The aim of the study: to determine the factors associated with the use of the IUD in women of childbearing age as a long-term contraceptive method in the working area of the Batu-Batu Health Center, Soppeng Regency. The results of the study: and mother culture. Conclusion: there is a significant relationship between attitude, mother's occupation and husband's support and experience of contraception towards IUD use in women of childbearing age, while the level of age, level of education, level of knowledge, parity and mother's culture do not have a significant relationship


INTRODUCTION
Currently, the problem that is being faced by the Indonesian state is the population problem. Based on Worldometers data, currently Indonesia's population is 269 million people or 3.49% of the total world population. Indonesia is ranked fourth most populous country in the world after China (1.4 billion people), India (1.3 billion people) and the United States (328 million people). The Central Statistics Agency (BPS) also projects this population to increase to 271 million in 2020 to 305 million in 2035 (Central Statistics Agency, 2018). In suppressing the rate of population growth, the Indonesian government implemented a program known as National Family Planning (KB) which is expected to reduce the rate of population growth (Setiawati, 2017). Law No. 52 of 2009 supports the Family Planning Program as one of the efforts to create healthy and quality families (Kemenkes RI, 2014). The government has tried to make the family planning program a success by providing 3 types of contraception free of charge in the form of condoms, IUDs (Intrauterine Contraception Devices) and pills. However, there has been a shift in the use of contraceptive service facilities by family planning participants, many family planning participants tend to choose private services (69%) over the government (22%) (Setiawati, 2017). The number of active family planning acceptors in Indonesia nationally in 2018 was in the range of 24,258,532 people. Where the number of South Sulawesi province is around 784,263 people. The most widely used contraceptive methods in South Sulawesi province were injections for 462,411 people (60.37%), pills for 158,150 people (20.65%), implants for 74,455 people (9.72%), IUDs for 27,609 people (3, 60%), MOW as many as 23,396 people (3.05%), condoms as many as 13,715 people (1.79%) and the least desirable, namely MOP as many as 6,187 people (0.81%). The data shows that the IUD is in fourth place after the injection, pill and implant methods (Kemenkes RI, 2018). The IUD as MKJP (Long Term Contraceptive Method) is less popular in society. Even though the IUD is a long-term contraceptive and is classified as a non-hormonal contraceptive so it does not interfere with the body's hormonal system. In addition, the IUD is also more practical and requires only one insertion and can last up to 10 years, depending on the user. MKJP preference coverage in Indonesia from 2009 to 2014 only ranged from 12.60% to 25.37%. The percentage of new MKJP participants in 2014 was implants 10.65%, IUDs 7.15% and MOW or MOP 1.71% (Ministry of Health RI, 2015). The population of South Sulawesi in 2015 reached 8.5 million, which is predicted to increase to 8.9 million in 2020. The population in Soppeng Regency in 2018 is 226,770 people.
In the teachings of Islam, contraception is defined as preventing pregnancy which has been since the time of the Prophet Muhammad‫ﷺ‬called 'azal which is now better known as coitusinteruptus, namely jima' interrupted, which means that ejaculation (inzal almani) is done outside the vagina (faraj) which causes sperm not to meet with the wife's egg. Thus, it is possible that pregnancy does not occur because the egg cannot be fertilized by sperm from the husband (al-Fauzi, 2017). Regarding 'azal in the hadith of Bukhari and Muslim it is narrated: Jabir's friend said: "We did 'azal at the time of the Prophet‫ﷺ‬while at that time the Koran was still being revealed, then the news of this incident arrivedto the Messenger of Allah and he did not forbid us" (al-Fauzi, 2017).
The hadith above shows that the act of 'azal was carried out as an effort to avoid pregnancy and this act is justified (no prohibition). If the act of 'azal is prohibited then of course it will be explained in the Koran which at that time the Koran was still revealed or even it would be confirmed by the prophet himself, but not done by the Messenger of Allah‫ (ﷺ‬al-Fauzi, 2017).
The purpose of this study was to determine the factors associated with the use of the IUD in women of childbearing age as a long-term contraceptive method in the working area of the Batu-Batu Health Center, Soppeng Regency.

METHODS
The type of research used was a descriptive survey with a cross-sectional study design to find out the factors associated with the use of the IUD as a long-term contraceptive method in women of childbearing age in the working area of the Batu-Batu Health Center, Soppeng Regency, in 2019. The correlation studied was the correlation between dependent (interest in using the IUD) and independent (age,level of education, knowledge, attitudes, parity, culture, contraceptive experience, employment and husband support). The research was conducted at the Batu-Batu Health Center, Marioriawa District, Soppeng Regency. This research was conducted in February 2020. The study population was all women of childbearing age (WUS) who were married and used contraception in the working area of the Batu-Batu Health Center, Marioriawa District, Soppeng Regency in . The number of WUS is 2017 people. The sample for this study were WUS who were married and used contraception in the working area of the Batu-Batu Health Center, Marioriawa District, Soppeng Regency from January to October 2019. Sampling was based on inclusion criteria and exclusion criteria as follows: The inclusion criteria in this study were: 1. Women using contraceptives 2. Good awareness and can communicate 3. cooperative The exclusion criteria in this study include: 1. Women who do not use contraception 2. Unmarried women 3. Menopausal women 4. The subject is not willing to be a respondent The required sample size in this study was determined based on the slovin formula.

Research Instrument
Questionnaires are used to obtain respondent information which is researched in a structured manner, there are a number of lists of questions and ask respondents to fill out a questionnaire.

Processing and Presentation of Data
Data processing was carried out electronically using the SPSS For Windows application and then presented in the form of frequency distribution tables and percentages accompanied by narrative explanations.

Research Ethics
Matters related to ethics in this study are: 1) Make a cover letter addressed to the relevant agency as an application for permission to carry out research 2) Convey the research objectives conducted to research subjects in a good and polite manner.
3) Guarantee the confidentiality of the respondent's identity so that no party feels disadvantaged. 4) Not forcing or intervening research subjects during the data collection process.

Results
This research was carried out at the Batu-Batu Health Center, Soppeng Regency, starting on 01 February 2020 -10 February 2020. Secondary data collection was carried out administratively to obtain the appropriate number of samples and primary data through direct visits to each sample for question and answer and filling out questionnaires by Mother. The sample of this research is 100 respondents. The data was then inputted and analyzed using the Chi Square statistical test with a significance level of p <0.05, as well as a  Table 1 shows aged women≤30 years as many as 24 people (24%) and mothers>30 years as many as 76 people (76%). 2) Level of education      Table 5 shows that 29 women (29%) have 1 child and 71 women (71%) have more than 1 child. 6) Culture   Table 8 shows 85 women who do not work (85%), 2 women who work in the home environment (2%), and 13 women who work outside the home environment (13%). 9) Husband support  Table 9 shows 39 women (39%) who received support from their husbands for contraception and 61 women (61%) who did not get support from their husbands for contraception.
b. Dependent Variable 1) Use of Contraceptive Methods  (2020) Table 10 shows that 4 respondents (4%) used the IUD as a contraceptive method and 96 respondents (96%) did not use the IUD.

Bivariate Analysis
This analysis aims to see the relationship between the dependent and independent variables using cross tabulation (crosstab). a. Relationship between age and IUD use  Table 11 shows that there is 1 person (25%) who uses an aged IUD≤30 years old, and 3 women (75%) who used IUDs were >30 years old. Meanwhile, women who do not use IUDs are aged≤23 people (24%) were 30 years old and 76 people (76%) did not use IUDs aged >30 years.
Based on the results of statistical tests using Chi Square, the p-value = 1,000 (p <0.05) was obtained. So it can be concluded that there is no significant relationship between age and IUD use. b. Relationship between education level and IUD use  Table 12 shows that there were 1 woman (25%) using the IUD with an elementary education level, 1 woman (25%) using the IUD with a junior high school level, and 2 women (50%) using the IUD with an education level College. Meanwhile, there were 23 women (24%) who did not use the IUD who had an elementary education level, 30 people (31%) had a junior high school education level, 27 people (28%) had a high school education level, and 16 people (17%) had a high school education level. higher vocational education. Based on the results of statistical tests using Chi Square, the p-value = 0.315 (p <0.05) was obtained. So it can be concluded that there is no significant relationship between education level and IUD use. c. Relationship between knowledge level and IUD use  Table 13 shows that there are 2 women (50%) who use the IUD with a sufficient level of knowledge, 2 people (50%) who use the IUD with a good level of knowledge. Meanwhile, 11 women (11.5%) who did not use the IUD had less knowledge, 48 people (50%) had sufficient knowledge, and 37 people (38.5%) had good knowledge. Based on the results of statistical tests using Chi Square, the p-value = 0.936 (p <0.05) was obtained. So it can be concluded that there is no significant relationship between the level of knowledge and IUD use. d. Relationship between attitude and IUD use  Table 14 shows that there were 1 woman (25%) who used the IUD with a negative attitude, 3 women (75%) who used the IUD with a positive attitude. Meanwhile, 74 women (77%) who did not use the IUD had a negative attitude towards IUD use and 22 women (23%) had a positive attitude. Based on the results of statistical tests using Chi Square, the p-value = 0.047 (p <0.05) was obtained. So it can be concluded that there is a significant relationship between attitudes and IUD use. e. Relationship between maternal parity and IUD use Table 15. Parity Relationship with IUD Use Source: Primary Data 2020 Table 15 shows that 1 woman (25%) used an IUD with 1 child and 3 women (75%) used an IUD with more than 1 child. Meanwhile, there were 28 women (29%) who did not use the IUD who had 1 child and 68 people (71%) who had more than 1 child. Based on the results of statistical tests using Chi Square, the pvalue = 1.000 (p <0.05) was obtained. So it can be concluded that there is no significant relationship between maternal parity and IUD use.
f. Cultural associations with IUD use In table 16 it was found that 1 person (25%) of women who used the IUD had obstacles in using the IUD, 3 people (75%) of women who used the IUD did not have cultural barriers. While women who did not use the IUD had cultural barriers as many as 34 people (35%), 62 people (65%) did not have cultural barriers. Based on the results of statistical tests using Chi Square, the p-value = 1.000 (p <0.05) was obtained. So it can be concluded that there is no significant relationship between culture and IUD use.
g. Relationship between contraceptive experience and IUD use  Table 17 shows that 3 women (75%) who used IUDs were new family planning acceptors, and 1 woman (25%) who used IUDs were old family planning acceptors. Meanwhile, 15 women (16%) who did not use the IUD became new family planning acceptors and 81 women (82%) who were old family planning acceptors. Based on the results of statistical tests using Chi Square, the p-value = 0.018 (p <0.05) was obtained. So it can be concluded that there is a significant relationship between contraceptive experience and IUD use.
h. Occupational relationship with IUD use Congested Table 18 found that 1 woman (25%) who used the IUD did not work, 1 person (25%) worked in the home environment and 2 women (50%) worked outside the home environment. Meanwhile, there were 84 women (88%) who did not use the IUD, 1 person (1%) who worked in the home environment and 13 people (13%) who worked outside the home environment. Based on the results of statistical tests using Chi Square, the p-value = 0.000 (p <0.05) was obtained. So it can be concluded that there is a significant relationship between work and IUD use.
i. Husband's support relationship with IUD use  Table 19 shows that 4 women (100%) who used IUDs supported the use of IUDs, while 61 women (64%) who did not use IUDs and 35 women (36%) who did not receive support did not receive support from their husbands. Based on the results of statistical tests using Chi Square, the p-value = 0.021 (p <0.05) was obtained. So it can be concluded that there is a significant relationship between husband's support and IUD use.

1.
Relationship between age and IUD use Based on the results of statistical tests using Chi Square, the p-value = 1,000 (p <0.05) was obtained. So it can be concluded that there is no significant relationship between age and IUD use. This research is in line with research conducted by Richi (2010) and Sri Umiyani (2010) which states that there is no relationship between the age factor and the choice of contraceptives. In that study it was said that women aged (> 35 years) and young (35 years) had no difference in using IUD and hormonal contraception such as pills and injections. In contrast to research by Purbaningrum (2015) (Asih et al, 2009). This research is not in line with research by Lilik Indahwati, et al (2017) which states that there is a significant relationship between education level and choice of contraceptive method (Indahwati, 2017 Kusumaningrum, 2009 stated that there was no relationship between parity and the use of IUD contraceptive methods. 6. Cultural associations with IUD use Based on the results of statistical tests using Chi Square, the p-value = 1.000 (p <0.05) was obtained. So it can be concluded that there is no significant relationship between culture and IUD use. This is in line with research conducted by Sri Wulandari (2015) which states that there is no relationship between culture and IUD use. 7. Relationship between contraceptive experience and IUD use Based on the results of statistical tests using Chi Square, the p-value = 0.018 (p <0.05) was obtained. So it can be concluded that there is a significant relationship between contraceptive experience and IUD use. This is in line with research conducted by Indahwati in 2017 which stated that there was a significant relationship between family planning experience and the choice of contraceptive method. 8. Occupational relationship with IUD use Based on the results of statistical tests using Chi Square, the p-value = 0.000 (p <0.05) was obtained. So it can be concluded that there is a significant relationship between work and IUD use. 9. Husband's support relationship with IUD use Based on the results of statistical tests using Chi Square, the p-value = 0.021 (p <0.05) was obtained. So it can be concluded that there is a significant relationship between husband's support and IUD use. This research is in line with research conducted by Sri Sulastri (2016) which suggested that there was a significant relationship between husband's support and the use of the IUD as a longterm contraceptive method. A study by Alemayehu et al. (2012) also showed that husband's support influences the choice of contraception.

CONCLUSION
From the results of research conducted in the Working Area of the Batu-Batu Health Center, Soppeng Regency in 2019 it was concluded that there was a significant relationship between attitude, mother's occupation and husband's support and mother's contraception experience on IUD use in women of childbearing age while age level, education level, level of knowledge , parity and mother's culture did not have a significant relationship.