The Impact of Covid-19 Pandemic on the Interest in Family Planning among Couples of Childbearing Age

The population growth rate in Indonesia has been declining recently. Family Planning program is an initiative of the Indonesian government that has been running since 1980. It has been successful in reducing the population growth rate. The number of children a woman has during her reproductive period is known as the total fertility rate. However, the Covid-19 pandemic has prompted worries about the rising birth rate as a result of the disruption of contraceptive services. In order to assist the government in gathering information on family planning acceptors among couples of childbearing age in Indonesia and to serve as a resource for courses on reproductive health and family planning, this study aims to determine the impact of Covid-19 pandemic on the interest in family planning among couples of childbearing age. This was a quantitative analytical study with a one-shot case study design. The study populations involved 137 participants of couples of childbearing age with children. All completed the questionnaire; 112 of them were selected using the total sample approach in accordance with the inclusion and exclusion criteria. Data obtained as the results of survey were tested for validity using the product moment validity test. Chi-square analysis was applied which obtained a p value of 0.003 or <0.05. It can be concluded that there was a strong correlation between family planning implementation and participation during the Covid-19 pandemic in September to December 2020.

The population growth rate in Indonesia has been declining recently. Family Planning program is an initiative of the Indonesian government that has been running since 1980. It has been successful in reducing the population growth rate. The number of children a woman has during her reproductive period is known as the total fertility rate. However, the Covid-19 pandemic has prompted worries about the rising birth rate as a result of the disruption of contraceptive services. In order to assist the government in gathering information on family planning acceptors among couples of childbearing age in Indonesia and to serve as a resource for courses on reproductive health and family planning, this study aims to determine the impact of Covid-19 pandemic on the interest in family planning among couples of childbearing age. This was a quantitative analytical study with a one-shot case study design. The study populations involved 137 participants of couples of childbearing age with children. All completed the questionnaire; 112 of them were selected using the total sample approach in accordance with the inclusion and exclusion criteria. Data obtained as the results of survey were tested for validity using the product moment validity test. Chi-square analysis was applied which obtained a p value of 0.003 or <0.05. It can be concluded that there was a strong correlation between family planning implementation and participation during the Covid-19 pandemic in September to December 2020. According to the study finding, couples of childbearing age were less interested in family planning as a result of the Covid-19 pandemic.

Introduction
Population is one of the variables that affect a country's degree of welfare since a large population would result in many health issues. Therefore, the government must pay more attention to an in increase population. In recent years, Indonesia's population growth rate has started to decrease. Family Planning program is an initiative of the Indonesian government that has been running since 1980. It has been successful in reducing the population growth rate. The population growth rate in Indonesia from 1971 to 1980 was still relatively high at about 2.31%. However, from 1990 to 2000 it decreased to 1.49%.
Such decrease was a result of many people who participated in government-sponsored family planning initiatives in the community (Adiyudha, 2020;Mulyani et al., 2019).
In essence, family planning has many goals beyond just lowering birth rates or preventing pregnancy, such as lowering the risk of abortion, lowering maternal and infant mortality, preserving family mental health, preventing the spread of HIV/AIDS, and preserving family economic stability.
The active engagement of Couple of Childbearing Age in the use of contraceptive methods is considered good, given the numerous benefits regarding improvement of the quality of life for all family members, society, and the nation (Gaffar & Abao, 2021;Nintyasari & Kumalasari, 2014).
There was a decrease in population growth rate for Indonesia between 2000 and 2017 to 1.36%.
Such finding is consistent with the result of the 2017 Indonesian Demographic Health Survey (IDHS), which showed a decline in the Total Fertility Rate (TFR). The number of children a woman has during her reproductive period is known as the total fertility rate. However, the Covid-19 pandemic has prompted worries about the rising birth rate as a result of the disruption of contraceptive services (Netral, 2019;Setiawan, 2020).
According to the National Population and Family Planning Board (BKKBN) data in 2020, there were a less number of people who participated in family planning program in March 2020 compared to February 2020. There were 36,155 IUD acceptors in February 2020, which decreased to 23,383. The number of implant, injections, tablets acceptors ranged from 81,062 to 51,536; condom acceptors ranged from 251,619 to 146,767, Male sterilization acceptors ranged from 2,283 to 1,196, and sterilization acceptors ranged from 13,571 to 8,093. The BKKBN and other related parties made every effort to ensure that couples of childbearing age continue to use contraceptive methods and medications during the pandemic period since the data raised concerns about the emergence of a surge in baby births following the Covid-19 pandemic (Listyawardani, 2020). Based on the aforementioned context, this study aims to determine the impact of Covid-19 pandemic on the interest in family planning among couples of childbearing age.

Methods
This was a quantitative analytical study with pre-experimental design that manipulated independent factors that were hypothesised to have an impact on the development of the dependent variable as the foundation of the analysis.
The study populations involved 137 participants of couples of childbearing ages with children.
All completed the questionnaire; 112 of them were selected using the total sample approach in accordance with the inclusion and exclusion criteria. The inclusion criteria involved couple of childbearing age aged under 20 years and had at least one living child. Meanwhile, the exclusion criterion was respondents who did not complete the google form questionnaire.
The current study was conducted in September to December 2020. A google form with several sent over social media, including Facebook (FB), Instagram (IG), and WhatsApp (WA), as the data collection instrument. The impact of Covid-19 pandemic on the interest in family planning among couples of childbearing age was then estimated and computed based on the information provided by respondents.
The product moment validity test method was applied in this study to evaluate the data validity.
Such test was performed to assess the accuracy of the analysis on how the Covid-19 epidemic had an impact on the interest of couples of childbearing age in family planning. Based on the comparison with r table (for N=112 respondents), it was obtained the r value of 0.186. Following data collection, the further step was analysis on data reliability. The Chi Square test was applied to assess the study variables, specifically nominal variables, with a relationship level of 0.05 (the x table value = 3.841).

Results
The results of study conducted online in September -December 2020 are presented in the table below.  Based on the results of the data analysis, it was found that among 112 respondents involved in this study, 55 respondents (49.11%) were family planning acceptor, 12 respondents (10.71%) were Nonacceptor. Furthermore, 45 respondents (40.18%) dropped out as family planning acceptors. There was an impact of the Covid-19 pandemic on the interest in family planning among couples of childbearing age, especially among respondents.

Discussion
Nearly everyone's lifestyle has changed as a result of the COVID-19 pandemic. Such pandemic situation also negatively impacted the use of contraceptive methods and disrupted the distribution of both drugs and contraceptives. People were hesitant to visit health facilities to have their reproductive health assessed, including to arrange contraceptive methods. On the other hand, medical staffs involved in reproductive health care were diverted to accommodate other requirements. For couples of childbearing age who require contraceptive use services and products, such conditions pose serious problems to their health and wellbeing (Aprillia et al., 2020).
People often experienced that visit to medical facilities during the Covid-19 pandemic was uneasy unimportant. According to the study findings, 45 respondents (40.18%) dropped out as family planning acceptors. People were reluctant to visit health services if they were not absolutely necessary because of the government's declaration of the COVID-19 outbreak as a national disaster, policies on quarantine measures, and mobility limitations (Sirait, 2021).
The finding of this study is consistent with a study conducted by Nurma on the factors that influenced contraceptive use during the COVID-19 pandemic, which found that age had a nonsignificant effect on the interest of couples of reproductive age to choose contraceptive methods. One of the reasons for an acceptor to stop the use of contraceptive method was the husband support (Aprilia Nurma, 2021).
According to the finding of a study conducted by Hanafi in 2019, the use of contraceptives would be positively and significantly impacted by the family economic level. This claim relates to the selection of contraceptive methods based on the expenses involved. According to the study conducted by Nyarko in 2015, the use of contraceptive techniques was correlated with income, education, and knowledge levels.
A decrease in the number of active family planning acceptors in this study is also consistent with a study conducted by Witono, et al. regarding participation in family planning program during the beginning of the Covid-19 pandemic. One of the causes was a decrease in the intensity of the expansion and operation of family planning services provided by healthcare services (Witono & Parwodiwiyono, 2020).
The significance of continuing to actively participate in family planning, growing the desire for family planning, and raising the acceptance of family planning among couples of childbearing age can help to lower the rate of unmet need for family planning. The choice of contraceptive method is another crucial consideration. For instance, compared to other contraceptive methods, injection has a pretty high failure rate. A woman may not use any contraceptive method because she is unaware of the effects on behavior, perceptions, motivation, and activities related to pregnancy (Fadhila et al., 2017;Musyayadah et al., 2022).
There is a significance of providing accurate information about the advantages, disadvantages, and side effects that family planning acceptors may encounter, as well as details about the locations of family planning services that continued to provide services during the Covid-19 Pandemic while adhering to strict health protocols (Adiyudha, 2020;Wijayanti et al., 2018). Accurate information can lessen patient apprehension and improve comprehension of couples of childbearing age and also enhance their confidence to use contraceptive methods.

Conclusions
The study findings indicated that although a significant proportion of couples of childbearing age who continued to use family planning methods, there was a decline in the interest in family planning among couples of childbearing age.