2 jt/thn (37/1000 15-49) di Indonesia2 15% kematian maternal

12/2/2016
R. Sutiawan1
*Sub Topik Kuliah Demografi Kesehatan, Program Magister IKM
1Dept
Biostatistika dan Kependudukan, FKMUI
15% kematian maternal disebabkan oleh
Abortion1
2 jt/thn (37/1000
) di Indonesia2
Strategi: kontrol unwanted pregnancy 
Contraceptive use
Fakta:  contra. prev   abortion rate
15-49
Data utk evaluasi  terbatas
Data Abortion  sulit dikuantifikasi
1WHO
(2003), Unsafe abortion: Global and Regional Estimates and Associated Mortality in Sout East Asia
B, et.al (2001), Community-Base Survey in 10 major Cities/6 District
2Utomo
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Skenario perubahan abortion rate
Model kaitan abortion rate dengan
“direct” determinannya
• Fertility preferences
– # anak diinginkan
(# anak diinginkan >>  unintended preg rate <<)
Pd masy  masa transisi fertilitas:
# anak diinginkan selama thn diperlukan utk mengandung
# thn dimana berisiko alami unintd.preg akan 
Pd masy paska transisi:
# unintd.preg >>, kecuali dg praktek kontrasepsi efektif
– Jarak antar kelahiran
yg lebih suka memperpanjangberisiko>> unintd.preg
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• Prevalence (effectiveness) of contraception
- unintd.preg mcegahnya dg kontrasepsi sempurna
- efektifitas metode < 100%
- prev.kontr bervariasi (<10% - 75%)
• Abortion probability of unintended pregnancies
- Aborsi nyata dipengaruhi: rate unintd.preg dan berapa
prob. kehamilan tsb berakhir dg aborsi (41-91%)3
- Aborsi >>  di masy. dg norma keluarga kecil;%kontr<<
3Alan
Guttmacher Institute(1999), Sharing Responsibility: Women, Society and Abortion Worldwide
KOREA
INDONESIA
Rate aborsi 2.2
Alan Guttmacher Institute 1999; Ross et al. 1999; Tietze 1979; United Nations 1999.
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TFR=Yr/Ib=8
Yr(1-u)=5
TFR=Yr(1-u)/Ib=2
Yri=TFR.Ib=5
Yr.e.u
Ia=1,251
TFR.Ib
TFR=2
Yr=(Yr.e.u)+(TFR.Ib)+(TAR.Ia)
u=0,751
TAR=Yr-Yri/Ia=12
TAR.Ia
Yr.u=15
Yra=TAR.Ia=15
1u=0,625;
e=1
TAR=2
Yr=20
Bongaarts, J .2000
YR = reproductive years; e = contraceptive effectiveness; u = contraceptive prev;
TFR = total fertility rate; IB = birth interval; TAR = total abortion rate; IA = interval of abortion
YR = reproductive years; e = contraceptive effectiveness; u = contraceptive prev;
TFR = total fertility rate; IB = birth interval; TAR = total abortion rate; IA = interval of abortion
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• paborsi=TAR/(TAR+UITFR)
• TFR=UITFR+ITFR
• YR = YR*e*u+TFR*IB+TAR*IA ….1
• TAR = YR(1–e*u)/IA–TFR*IB/IA……1.1
• TAR = p*(YR*(1–e*u)–ITFR*IB)/(p*IA+(1–p)*IB)
•
(unintended: mistimed, unplanned or unwanted at the time of fertility)
YR = reproductive years; e = contraceptive effectiveness; u = contraceptive prev;
TFR = total fertility rate; IB = birth interval; TAR = total abortion rate; IA = interval of abortion
Abortion Determinants
Total Fertility Rate (TFR)
Total Abortion Rate (TAR)
Wanted Total Fertility Rate
(WTFR)
Intended Total Fertility Rate
(ITFR)
Abortion Probability (p)
Reproductive Years (YR)
Average Birth Interval (IB)
Contraceptive Prevalence (u)
Perfective Contraceptive Prev
(up)
Contraceptive Effectiveness (e)
Abortion Interval (IA)
1991
2,8
4,6
1994
2,7
3,8
1997
2,61
2,54
2002
2,55
2,38
2007
2,602
1,75
2,7
2,51
2,46
2,4
2,46
2,3
2,22
2,15
2,19
2,13
0,9
22,7
2,3
0,49
0,9
22,6
2,4
0,52
0,85
22,5
2,5
0,55
0,83
22,3
2,7
0,59
0,8
22,1
2,9
0,59
0,77
0,71
0,71
0,7
0,68
0,96 0,97 0,98 0,94
0,96
is assumed: 14 months (Bongaarts)
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Ada 6 faktor  mpengaruhi variasi angka aborsi
Variasi penurunan aborsi melalui:
Pengendalian langsung melalui:
Program KB; akses dan efektifitas penggunaan alokon (>68%)
Meningkatkan rata2 usia kawin pertama (1+thn)
memperpanjang jarak antar kelahiran ( 3thn)
Model alternatif  kuantifikasi perencanaan
YR = reproductive years; e = contraceptive effectiveness; u = contraceptive prev;
TFR = total fertility rate; IB = birth interval; TAR = total abortion rate; IA = interval of abortion
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• TFR=5ASFRi; ASFR=Bi/Pfi*k
• Rata2 total jml anak yg dimiliki oleh 1 org
wanita selama masa reproduksi
• Utk wanita pernah kawin, usia 15-49 th
• Umur responden; p105-106
• Jml kelahiran pd umur tertentu sebelum
survei; p212-221; kalender
YR = reproductive years; e = contraceptive effectiveness; u = contraceptive prev;
TFR = total fertility rate; IB = birth interval; TAR = total abortion rate; IA = interval of abortion
• WTFR
• Rata2 total jml anak yg diinginkan oleh 1
wanita selama masa reproduksi
• Jml anak yg diinginkan selama hidup
• Waktu lahir sesuai rencana+tdk sesuai
rencana
• Jml anak yg diinginkan selama hidup; p614
YR = reproductive years; e = contraceptive effectiveness; u = contraceptive prev;
TFR = total fertility rate; IB = birth interval; TAR = total abortion rate; IA = interval of abortion
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• ITFR=5IASFRi
• Rata2 total jml anak yg diinginkan oleh 1
wanita dan wkt kelahiran sesuai dgn rencana
selama masa reproduksi
• Utk wanita umur tertentu yg sedang hamil
saat survei
• Menginginkan kehamilan tsb; p228
YR = reproductive years; e = contraceptive effectiveness; u = contraceptive prev;
TFR = total fertility rate; IB = birth interval; TAR = total abortion rate; IA = interval of abortion
• TAR=5ASARi
• Rata2 total jml aborsi tiap 1 wanita selama
masa reproduksi
• Pernah hamil yg berakhir dgn keguguran,
digugurkan atau lahir mati sebelum periode
survei; p229-234; kalender
YR = reproductive years; e = contraceptive effectiveness; u = contraceptive prev;
TFR = total fertility rate; IB = birth interval; TAR = total abortion rate; IA = interval of abortion
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• paborsi=TAR/(TAR+UITFR)
• Probabilitas/peluang kehamilan yg berakhir
dengan aborsi
• UITFR=TFR-ITFR
YR = reproductive years; e = contraceptive effectiveness; u = contraceptive prev;
TFR = total fertility rate; IB = birth interval; TAR = total abortion rate; IA = interval of abortion
• Yr
• Rata2 lama wkt (tahun) dimiliki 1 wanita (15-49) yg
berisiko utk hamil
• [35 – (masa hamil, postpartum, menyusui)]*proporsi
kontrasepsi
• Masa hamil = jml anak lahir pd periode survei*9 bln
• Masa post = jml anak lahir pd periode survei*40 hr
• Masa menyusui = jml anak lahir pd periode survei*6 bln
• Prop kontr = jml bln pakai / 72 bln
YR = reproductive years; e = contraceptive effectiveness; u = contraceptive prev;
TFR = total fertility rate; IB = birth interval; TAR = total abortion rate; IA = interval of abortion
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• Ib Interval kelahiran
• Rata2 rentang wkt yg diperlukan utk 1
kelahiran (ke kelahiran berikutnya)
• Selisih tahun lahir anak pertama dgn yg
terakhir;p215 / jml anak pernah lahir hidup;
p208
YR = reproductive years; e = contraceptive effectiveness; u = contraceptive prev;
TFR = total fertility rate; IB = birth interval; TAR = total abortion rate; IA = interval of abortion
•
•
•
•
u prevalensi kontrasepsi
Utk wanita kawin 15-49 th
Responden tdk steril; p302(01-02)
Responden (pasangan) pengguna
kontrasepsi pd periode tertentu sebelum
survei; p302-304
YR = reproductive years; e = contraceptive effectiveness; u = contraceptive prev;
TFR = total fertility rate; IB = birth interval; TAR = total abortion rate; IA = interval of abortion
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• e : efektifitas penggunaan kontrasepsi
• e = 1 - failure rate
• f: The percentage of women using a particular contraceptive method who experience an
unintended pregnancy in the first year of use
• Utk wanita kawin 15-49 th
• Responden tdk steril; p302(01-02)
• Responden (pasangan) pengguna kontrasepsi pd
periode tertentu sebelum survei; p304
• Kalender KB; p318 kolom 1-3
YR = reproductive years; e = contraceptive effectiveness; u = contraceptive prev;
TFR = total fertility rate; IB = birth interval; TAR = total abortion rate; IA = interval of abortion
• up prevalensi kontrasepsi sempurna
• up = 1-fr*[(1 - (WTFR*Ib)/Yr)]
YR = reproductive years; e = contraceptive effectiveness; u = contraceptive prev;
TFR = total fertility rate; IB = birth interval; TAR = total abortion rate; IA = interval of abortion
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