Utilization of Contraceptive Methods by Postpartum Patients at An-Nisaa' Hospital Blitar During the COVID-19 Pandemic

Introduction: The COVID-19 pandemic has had a significant impact on various aspects of health services, one of which is access to contraception. Objective: The people of Blitar Regency, in choosing the Long-Term Contraceptive Method, have preferences that refer to safe use, ease to use, effectiveness, and advantages over other methods. Method: This research is quantitative descriptive research. This research was conducted to describe the use of contraceptive methods in postpartum patients at An-Nisaa Hospital in 2020 and 2021. Data analysis used univariate or descriptive analysis by looking at the frequency distribution of each contraceptive method used. Result and Discussion: Generally, the percentage of acceptors for postpartum patients compared to the number of deliveries is still at the same percentage, namely 67.64% in 2020 and 69.4% in 2021. Conclusion: The result is that the intrauterine device (IUD) method of contraception was widely chosen by patients postpartum during 2020-2021, where in 2020 there were 91.66% of Family Planning acceptors, and in 2021 there were 92.23% of PROGRAM KELUARGA BERENCANA PASCA PERSALINAN acceptors chose intrauterine devices.


Introduction
According to the World Health Organization (WHO), the maternal mortality rate (MMR) is death during pregnancy or within 42 days after the end of pregnancy from all causes related to or aggravated by the pregnancy or its management but not caused by accident or injury.The Maternal Mortality Rate is a sensitive indicator in describing a country's society's welfare.Based on 2012 Indonesian Demographic and Health Survey, the maternal mortality rate in Indonesia is still high at 359 per 100,000 live births (Ministry of Health, 2013) in (Indrayani, 2018).Furthermore, based on the 2015 Inter-Census Population Survey results, the average MMR is still high, namely at 305 per 100,000 live births (Suarayasa, 2020) According to the four pillars of the Safe Motherhood effort, one way to reduce maternal mortality is to reduce the possibility of a woman becoming pregnant with the Family Planning Program (Abbas et al., 2017).Family planning is designed so that every couple of childbearing age can adequately manage the time, number and spacing of healthy and ideal births according to their reproductive goals.With good family planning, a mother's pregnancy is managed so that it does not occur at too young, too old pregnancies, too many meetings and too many.WHO says the Family Planning Program contributes 30-40% to reducing MMR According to the Regulation of the Head of the National Population and Family Planning Agency Number 24 of 2017, as a standard indicator of achievement of the postpartum Family Planning Program, 70% of mothers giving birth use contraception, and 70% of mothers giving birth, 50% of them use long-term contraceptive methods (Haryani and Syuhada, 2022).Based on the health profile of the East Java Province in 2020, the achievements of the Postpartum Family Planning Program reached 53.43%, and the achievements in Blitar Regency were still below those of the East Java Province (East Java Health Office, 2020).The achievement of Family Planning Program services that have not met the target can also be seen from the Contraception Prevalence Rate (CPR) in the 2012 IDHS, which only reached 61.9% (Statistics Indonesia, 2012) in (Purnandias, Mawarni, and Dharminto, 2018) Most of the participants in the active family planning program still use short-term hormonal contraception (Setiasih, Widjanarko, and Istiarti, 2016).Then, the use of Long-Term Contraceptive Methods tends to be less desirable.This can be seen from using one of the Long-Term Contraceptive Methods, the Intrauterine device (IUD), which has decreased from the 2007 Indonesian Demographic and Health Survey Data from 4.9% to 3.9% in 2012 (Laili, 2022).
East Java Province Health Profile Report 2012 2020 shows that the choice of contraceptive method for the Family Planning Program that dominates is the Non-Long-Term Contraceptive Method, namely the Injection method of 68.87%, meanwhile for the Long-Term Contraceptive Method, namely the IUD, it is only found at 8.56% (East Java Health Office, 2020).Even though the Long-Term Contraceptive Method is an effective method of contraception.Given the relatively high dropout in the use of non-Long-Term Contraceptive Methods, contraceptive services are directed to choose effective contraceptive methods, namely Long-Term Contraceptive Methods such as implants and IUDs (Sari, 2016) The Coronavirus Disease-19 (COVID-19) pandemic, especially the one that was felt the most in 2020, played a role in exacerbating various aspects related to contraception.The COVID-19 pandemic has not created new problems for contraceptive acceptors, but it has exacerbated existing problems.As discussed above, the contraceptive target in East Java Province still needs to be met.The COVID-19 pandemic exacerbated this in various countries worldwide (Smith et al., 2021).
In general, the COVID-19 pandemic has exacerbated structural inequities in various countries.The United States notes this structural injustice has become even more aggravating during the COVID-19 pandemic.Several ways contribute to the decline in access to contraception.The COVID-19 pandemic has resulted in fear of infection, limited space for movement and movement of places, and limited access to health facilities (Aly et al., 2020) Because of the reasons mentioned above, researchers are interested in researching the rate of contraceptive use at An-Nisaa' Hospital Blitar during the COVID-19 pandemic.Researchers want to know the extent of the impact of the COVID-19 pandemic on contraceptive use and access in Blitar Regency.It aims to determine contraception use during the COVID-19 pandemic at An-Nisaa' General Hospital, Blitar Regency.

Method
This research is quantitative and descriptive.This study was conducted to describe the use of contraceptive methods in postpartum patients at An-Nisaa' Hospital during the COVID-19 Pandemic.Technically the COVID-19 Pandemic did start in 2019, but its impact can only be felt in early 2020.Therefore, this research is focused on contraceptive use in postpartum patients in 2020 and 2021.This research was conducted in July-August 2022.The population in this study were women who gave birth by vaginal delivery and cesarean section at An-Nisaa' Hospital during the COVID-19 Pandemic from 2020-2021.The data used is secondary data.The data taken was in the form of monthly reports from the delivery room on the number of patients who became acceptors of the postpartum family planning program at An-Nisaa' Hospital.Data analysis used univariate or descriptive analysis by looking at the frequency distribution of each contraceptive method used.

Result
The study's results can be seen in table 1 and table 2  The most popular postpartum contraceptive method in 2020 is the IUD.IUD was chosen by 506 out of 552 patients who chose to do the postpartum family planning program (91.66%).While 14 mothers only chose the implant method (2.53%), and tubectomy (MOW) was chosen by 32 mothers (5.79%).The most used IUD in 2020 was in October, with 65 people out of 67 acceptors, which was also the month when the percentage of IUD voters was highest among acceptors (97.02%).The least frequent IUD placement was carried out in September because only 14 patients used IUDs out of 15 acceptors (93.33%). The

Discussion
In 2020 the number of deliveries and acceptors of the postpartum Family Planning Program was lower compared to 2021.In 2020 there were 816 total deliveries, while in 2021, there were 1206 deliveries.In addition, the total number of postpartum family planning program acceptors is also much lower in 2020, namely only 552 postnatal family planning program acceptors compared to 837 postnatal family planning program acceptors in 2021.In general, the percentage of postnatal family planning program acceptors compared to the total deliveries are still at the same percentage, namely 67.64% in 2020 and 69.4% in 2021.
This condition is thought to be caused by the COVID-19 Pandemic, which first hit the Asian continent.Countries in Asia, including Indonesia, were the first to be affected and the earliest to adapt to the COVID-19 Pandemic.This adaptation to drastic changes in the health system was mainly carried out at the beginning of 2020.It is this condition that may have caused the number of deliveries and the number of postnatal Family Planning Program acceptors to be lower in 2020 compared to 2021, even though the percentage of acceptors to the postnatal Family Planning Program deliveries in 2020 and 2021 are not significantly different (Aly et al., 2020) Various studies regarding contraception during the COVID-19 Pandemic found that there were general problems with access to contraception and health services.This study found a higher demand for health services, a decrease in the number of health service providers, and various barriers to health and contraceptive services (Polis et al., 2022) The study conducted by Roland et al. has the same findings as our study, the study aims to look at the use of contraception after 15 months of the COVID-19 Pandemic.One of the most affected is long-term contraception, namely the IUD.IUD use was found to decrease by 8.6%, and implant use decreased by 16.4% (Roland et al., 2022) The postpartum family planning program is a strategic effort to reduce MMR.The Postpartum Family Planning Program is nothing new; since 2007, through the Birth Planning and Complications Prevention Program, it contains a delivery mandate that contains planning for the use of the postpartum Family Planning Program.From the monthly report data for the delivery room unit at An-Nisaa' Hospital during 2021, 837 patients had carried the postpartum family planning program out of a total of 1206 delivery patients, and this shows that the achievements of the postpartum family planning program at An-Nisaa' Hospital amounted to 69 40% of the total number of deliveries.
Per the 2017 National Population and Family Planning Agency Regulations, where the success indicator for the postpartum Family Planning Program is that 70% of mothers giving birth use contraception, the achievements at An-Nisaa' Hospital have almost reached the success indicators, namely 69.40% and 67.64%This is inseparable from the role of the health workers on duty who always provide education and counselling from the time of pregnancy, before and after delivery to prospective participants.The education and counselling in the 2017 Regulation contains guidance on doing this.Education and counselling deliver and receive messages to improve prospective participants' knowledge, attitudes and behaviour in the postpartum Family Planning Program.Counselling is a process of exchanging information and positive interaction about the Family Planning Program, carried out between potential participants of the Family Planning Program and officers to help potential participants of the Family Planning Program recognize their contraceptive needs and choose the best solution and make decisions that are appropriate to the conditions they face.Counselling is successful when counselling can help Family Planning Program participants choose and use the Family Planning Program method that suits them.The best counselling is carried out with different approaches according to the conditions of the potential participants or participants (BKKBN, 2017).
According to research by Abbas M. et al. (2012), there is a relationship between giving counselling to postpartum patients in the 1st stage of the latency phase and participating in the postpartum family planning program.Patients who receive counselling tend to become participants in the family planning program compared to those who do not receive counselling (Manurung, 2013) Referring to the recommendation of the 2009 Indonesia Health Technology Assessment, all hormonal and non-hormonal methods can be used as methods in the service of the Family Planning Program.

Connclusion
The method of contraception at An-Nisaa' Hospital that is most frequently chosen is the IUD method, with a total percentage of 92.23% in 2021 and 91.66% in 2020.In general, there is an increase in the number of deliveries and acceptors of the Family Planning Program in 2021 compared to 2020.This research proves that the IUD contraceptive method was in great demand by acceptors of the postpartum Family Planning Program during the COVID-19 pandemic.The COVID-19 pandemic has had a significant impact on reducing access to contraceptive services.

of Contraceptive Methods by Postpartum Patients at An-Nisaa' Hospital Blitar During the COVID-19 Pandemic achievement
. Table1describes the recapitulation data of pregnant women who completed the postpartum family planning program in 2020.Table 2 describes the recapitulation data of pregnant women who completed the postpartum family planning program in 2021.The total number of patients who implemented the postpartum family planning program in 2020 in 522 patients.The Yuriska Mayda Sumantri, Puspita Handayani/KESANS Utilization of the Family Planning Program in 2020 was 67.64%, with a total of 522 patient acceptors out of 816 patients who gave birth.Most of the Family Planning Programs were carried out in July, with 69 patients out of 91 who gave birth.Meanwhile, the fewest acceptors were found in September, with 15 patients who became acceptors out of 50 who underwent childbirth.Meanwhile, the best achievement of the Family Planning Program was found in January, with 27 acceptors out of 32 maternity patients (84.375%).The worst achievement of the Family Planning Program was found in September 2020, with an achievement of 50%.Recapitulation of Family Planning Program Methods at An-Nisaa' Hospital in 2020

Table 2
Recapitulation of Family Planning Program Methods at An-Nisaa' Hospital in 2021 total number of patients carrying out the postpartum family planning program in 2021 was 837 out of 1,206 who gave birth.The results of the postpartum family planning program in 2021 amounted to 69.40%.Of this total, the most patients who carried out the postnatal family planning program were found in August 2021, with 90 of the 113 patients who gave birth.Meanwhile, there were at least 59 patients out of 92 patients carried out the postpartum family planning program in November 2021.The highest achievement of patients who completed the postpartum Family Planning Program in April 2021 reached 82.65%.In contrast, out of 98 patients who gave birth, 81 completed the postpartum Family Planning Program.The postnatal Family Planning Program contraceptive method most in demand by Family Planning Program acceptors is the IUD; throughout 2021, most patients have chosen IUDs.Most patients chose IUDs in August, namely 87 patients out of 113 patients who gave birth.Meanwhile, patients rarely chose an IUD in January 2021; namely, only 55 patients out of 94 gave birth.Then for the choice of postnatal Family Planning Program contraceptive method, second place is MOW.MOW was mainly carried out in January, July and October 2021 by seven people.MOW was most rarely carried out in September 2021; as many as 2 out of 94 people gave birth.For contraception, less desirable methods are implants.Patients only opt for implants in March and April 2021.