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R. Sutiawan1
*Sub Topik Kuliah Demografi Kesehatan, Program Magister IKM1Dept Biostatistika dan Kependudukan, FKMUI
1WHO (2003), Unsafe abortion: Global and Regional Estimates and Associated Mortality in Sout East Asia2Utomo B, et.al (2001), Community-Base Survey in 10 major Cities/6 District
2 jt/thn (37/1000 15-49) di Indonesia2
15% kematian maternal disebabkan olehAbortion1
Strategi: kontrol unwanted pregnancyContraceptive useFakta: contra. prev abortion rate
Data utk evaluasi terbatasData Abortion sulit dikuantifikasi
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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 kelahiranyg lebih suka memperpanjangberisiko>> 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 berapaprob. 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
Alan Guttmacher Institute 1999; Ross et al. 1999; Tietze 1979; United Nations 1999.
KOREA
INDONESIA Rate aborsi 2.2
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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.u=15Yr(1-u)=5
TFR=Yr/Ib=8
TFR=Yr(1-u)/Ib=2u=0,751
Yr=20
Yri=TFR.Ib=5Yra=TAR.Ia=15TAR=Yr-Yri/Ia=12Ia=1,251
Yr.e.u TFR.Ib TAR.Ia
Yr=(Yr.e.u)+(TFR.Ib)+(TAR.Ia)
1u=0,625; e=1
TFR=2 TAR=2
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 1991 1994 1997 2002 2007Total Fertility Rate (TFR) 2,8 2,7 2,61 2,55 2,602Total Abortion Rate (TAR) 4,6 3,8 2,54 2,38 1,75Wanted Total Fertility Rate(WTFR) 2,7 2,51 2,46 2,4 2,46
Intended Total Fertility Rate(ITFR) 2,3 2,22 2,15 2,19 2,13
Abortion Probability (p) 0,9 0,9 0,85 0,83 0,8Reproductive Years (YR) 22,7 22,6 22,5 22,3 22,1Average Birth Interval (IB) 2,3 2,4 2,5 2,7 2,9Contraceptive Prevalence (u) 0,49 0,52 0,55 0,59 0,59Perfective Contraceptive Prev(up) 0,77 0,71 0,71 0,7 0,68
Contraceptive Effectiveness (e) 0,96 0,97 0,98 0,94 0,96Abortion Interval (IA) 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=5ASFRi; ASFR=Bi/Pfi*k
• Rata2 total jml anak yg dimiliki oleh 1 orgwanita 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=5IASFRi
• Rata2 total jml anak yg diinginkan oleh 1wanita dan wkt kelahiran sesuai dgn rencanaselama masa reproduksi
• Utk wanita umur tertentu yg sedang hamilsaat 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=5ASARi
• Rata2 total jml aborsi tiap 1 wanita selamamasa reproduksi
• Pernah hamil yg berakhir dgn keguguran,digugurkan atau lahir mati sebelum periodesurvei; 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 sebelumsurvei; 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