DIFFERENCE IN LENGTH OF RETURN OF FERTILITY AFTER CONTRACEPTION WITH 3-MONTH OF DEPO MEDROXY PROGESTERON ACETATE INJECTION AND HORMONAL IMPLANT IN BAUMATA PUBLIC HEALTH SCENTER, KUPANG DISTRICT

Siti Nur Asyah Jamillah Ahmaad, Dina M.S Henukh

Study Program in Diploma-III, Universitas Citra Bangsa, Kupang

ABSTRACT

Background: The length of fertility after stopping the use of DMPA injection takes an average of 4 to 10 months, while the FP implant takes 1 to 3 months. This study aimed to analyze the difference in duration of fertility return at 3-month injection contraceptive post acceptors (DMPA) and implant contraception at Baumata Health Center. Subjects and Method: This was an analytic study with a cross sectional design. The study was conducted in Baumata Community Health Center, Kupang Regency from November to December 2019. A sample of 40 post-acceptors for injection and implant family planning was selected by sampling technique. The dependent variable was Length of return of fertility. The independent variables were post acceptors for injection and implant family planning. The data were collected by questionnaire and tested by Mann-Whitney test. Results: Length of return to fertility in post-acceptors of injection family planning mothers at Baumata Public Health Center (Mean= 7.65; SD= 2.23). The return of fertility to post-acceptor implant family planning mothers at Baumata Community Health Center, Kupang Regency (Mean= 3.05; SD= 0.99). It was statistically significant (p< 0.001). Conclusion: Based on the tests that have been carried out, it can be concluded that there is a difference in the duration of return of fertility in mothers of injection and implant family planning post acceptors at Baumata Community Health Center, Kupang Regency.

Keywords: injection and implant family planning post acceptors, duration of return of fertility

Correspondence: Siti Nur Asyah Jamillah Ahmad. Study Program in Diploma-III, Universitas Citra Bangsa, Kupang. Jl. Manafe No. 17 Kayu Putih, Oebobo district, East Nusa Tenggara, Indonesia. E-mail: [email protected]. Mobile: 085338191820

BACKGROUND Based on the pattern in the selection of Based on data from the National contraceptive types most of the active kb Population and Family Planning (BKKBN) participants of NTT province chose in Indonesia in 2012 recorded the number injections (59.27%) as a contraceptive of 35,845,298 kb active acceptance of compared to other methods; Implant injectable kb users as much as (46. 84%), (17.31%), IUD (8.05%), Pill (17.24%), MOW as many pills (25. 13%), IUD as much as (4.50%), MOP (0.64%), Condoms (0.45%). (11. 53%), implants as much (8. 17%), The percentage of PUS participants in NTT Female Operative Method (MOW) as province's long-term contraceptive method much as (3. 49%), condoms (3.13%), and was 30.49% (Dinkes NTT, 2017). Male Operative Methods (MOP) as much Based on data in 2018 at the Baumata as (0. 70%) (Ministry of Health RI, 2013). Health Center Kupang regency the number of active kb participants as many as 2,192

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participants, from 80 active participants. 2014). implant is one type of 15% use injectable birth control, 16.83% hormonal birth control containing the used pills, 0.86%used steady contraception, hormone progestin. Kb implants belong to 2.1%used birth control implants, and 0.04 the type of long-term KB. Hormones using condoms, while based on the results of contained in birth control implants can interviews with 1 post injectable birth prevent pregnancy by inhibiting the control acceptance person who was journey of sperm to meet the ovum, pregnant said that it took 8 months to get inhibiting the release of eggs, and back pregnant again after stopping using preventing the implantation of the ovum injectable birth control. The results of the in the uterus. interview on 1 person post-acceptance KB However, it is undeniable that the implant said pregnant again after quitting limitations of the use of contraceptives using kb, took 5 months. include the problem of slow fertility return. A widely used type of contraceptive is After discontinuing the use of injectable hormonal contraceptives available in oral, contraceptive methods DMPA many injectable and implantable forms. Hormonal complained of difficult or long to conceive contraceptive methods are considered one again because it is not like the use of pills or of the methods with a high degree of AKDR (contraceptives in the womb), effectiveness. Still, on the other hand, fertility returns faster after the cessation of hormonal contraceptives, especially those use of pills or AKDR that is an average of 2 containing progestin, can change the months, while after cessation of injectable menstrual cycle and the return of fertility. use DMPA takes an average of 4 to 10 These changes are not predictable, varying months (Hartanto, 2020). between each woman to some degree against There are even some women who wait contraceptive methods. In most users, there years for pregnancy after the use of such is an increased incidence of irregular and contraceptives. One of the things that need slight blood spots or bleeding outside the attention after the use of a contraceptive is sometimes prolonged cycle, and sometimes the return of fertility. Fertility delay after with oligomenorrhea or even amenorrhea injection of DMPA is not caused by (Hartanto, 2020). abnormalities or damage to genitalia organs, One of the types of effective but because there is still a continuous contraceptives that mothers choose is release of gestagen (hormone ) injectable birth control; this is because it from the depot formed at the injection site. is safe, effective, simple and inexpensive. After taking off the implant, the body needs This method began to be liked by the to adapt to changes in hormone levels to public, and the public used contraceptive return to the state before using the implant. injections to prevent pregnancy. It usually takes 1-3 months for fertility to However, injectable birth control return. The use of implant contraceptives also has many side effects, such as can also affect fertility; it can even last amenorrhea, spotting, menorrhagia and months or years (Previyanti, 2017). The use menometrorrhagia, as well as other of implant contraceptives against the return hormonal contraceptives and also found of fertility rates fairly quickly after removal complaints of nausea, headaches (Saifuddin, 2010). (dizziness), weight changes (Sulistyawati,

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Research that has been done about the retrieval time in November - December return of fertility after stopping using 2019. Sampling technique used is accidental contraceptives is after one year of sampling. The number of samples in this observation, the incidence of pregnancy in study was 40 respondents consisting of the former acceptance of LNG (implant) is post-acceptance of injectable birth control 76. 5 per 100 women, while in the second and implants. year the incidence of pregnancy is 90. 2 per 3. Study Variables 100 women (Affandi, 1987). Previous The independent variables in this study were research has also been conducted concluded post-acceptance of injectable birth control that the length of use of DMPA injectable and implants while the dependent variables birth control in women Ex-Acceptor of in this study were the length of fertility contraceptive injection user DMPA on return. average is 25. 39 months while the length of 4. Definition Operational Variable fertility return in women Ex-Acceptor of The length of fertility return is the time contraceptive injection user DMPA average required for post acceptors of 3 months is 8. 82 months (Handayani dkk, 2010). DMPA injection and implant contraception, On the other hand, stated that there is from stopping using contraceptives to no effect of implanted contraceptives on pregnancy HPHT. fertility return (Saifuddin, 2010). While in DMPA is a monthly injection contraceptive other opinions state that the use of which is given every 3 months using a implanted contraceptives affects the return muscular injection containing the hormone of fertility (Previyanti, 2017). The purpose of progesterone, which contains 150 mg/ml of this study is 1) Identify the length of use of Depon Medroxy Progesterone Acetate. injectable contraceptives 3 months DMPA Minimum usage time of 1 year. against the return of fertility in post- Implant is a type of contraception that is acceptance. 2) Identify the length of use of inserted under the skin, which has fairly implanted contraceptives against the return high effectiveness and is long-term of fertility in post-acceptance. 3) Measuring contraception consisting of 2 sticks filled the difference in the length of fertility return with 75 mg of for 3 years of in post contraceptive acceptance Injectable use. 3 months DMPA and contraceptives. 5. Study Instruments Therefore, this study aims to find out Data retrieval in this study uses primary and the difference in the length of fertility return secondary data. The data collection tool at in post-acceptance contraceptive injectable the time of research is a questionnaire sheet. 3 months DMPA with post-acceptance KB 6. Data Analysis implant. Data analysis used by univariate, bivariate uses Test of Normality to determine normal SUBJECTS AND METHOD distributed data or not then tested using 1. Study Design Mann-Whitney test with thehelp of IBM This research design uses analytical research SPSS Statistics 20 application. design with sectional cros approach 2. Population and Sample RESULTS The research was conducted at Baumata 1. Sample Characteristic Health Center kupang regency with data

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Based on table 1 above can be interpreted is 50% high school, 40% junior high school, that from 20 respondents mother post- and 10% higher education. acceptance KB Injectable in Puskesmas Based on the table above can be Baumata most of the 90% aged 20-35 years interpreted that from 20 respondents and a small or 10% aged >35 years, then mother Post Acceptance KB Injectable in post-acceptance KB Implant in Puskesmas Puskesmas Baumata, mothers who work as Baumata most of the 90% aged 20-35 years housewives 85% and as farmers 15%and and a small or 10% aged >35 years. from 20 respondents mother Post Based on table 1 above can be Acceptance KB Implant in Puskesmas interpreted that from 20 respondents post- Baumata, mothers who work as housewives acceptance mother injecting kb in 70%, as Private Employees 25% and as civil Puskesmas Baumata, 40% high school servants 5%. education level, 35% junior high school The length of fertility return in education level, and 25% elementary school implanted birth control acceptance is level. Based on the table above can be shorter (months) (Mean= 3.05; SD= 0.99) interpreted that from 20 respondents post- instead of injectable birth control (Mean= acceptance mother KB Implant in 7.65; SD= 2.23). It was statistically Puskesmas Baumata, the level of education significant (p< 0.001).

Tabel 1. Sampel Characterisctic Variable Frequency (n) Percentage (%) Post Injectable KB Acceptor Age <20 0 0 20-35 18 90 >35 2 10 Education Sd 5 25 Junior 7 35 Sma 8 40 Pt 0 0 Job IRT function 17 85 Civil Servants 0 0 Private employees 0 0 Farmers 3 15 Post Acceptance KB Implant Age <20 0 0 20-35 18 90 >35 2 10 Education Elementary 0 0

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Junior High School 8 40 Senior High School 10 50 University 2 10 Job housewife 14 70 Civil Servants 1 5 Private employees 5 25 Farmers 0 0

2. Univariate Analysis Table 2 Differences in Fertility Return in Post Acceptance of Injectable and Implanted Birth Control Variable Mean SD p Long Return of Fertility In Injectable Birth Control 7.65 2.23 <0.001 Long Return of Fertility In Birth Control 3.05 0.99

DISCUSSION This is supported by research that has been Hormonal contraceptives are contraceptives done about the return of fertility after where and progesterone provide stopping using contraceptives is after one feedback to the pituitary gland through the year of observation, the incidence of hypothalamus resulting in resistance to pregnancy in former LNG acceptance follicles and ovulation processes (Manuaba, (implant) is 76.5 per 100 women, while in 2010). Injectable contraceptive 3 months the second year of pregnancy the incidence DMPA is a monthly injectable contraceptive of pregnancy is 90.2 per 100 women that is administered every 3 months with (Affandi, 1987). muscular injection (Mulyani and Rinawati, Previous research has also been 2013). conducted to conclude that the length of use Implantation is a contraceptive of DMPA injectable birth control in women inserted into the under the skin, which has Ex-Acceptor of contraceptive injection user fairly high effectiveness and is a long-term of DMPA injectable birth control is on and effective contraceptive for mothers who average 25.39 months while the length of should not use drugs containing estrogen fertility return in women Ex-Acceptor of (Wiknjosastro, 2014). Fertility is the ability contraceptive injection user of DMPA of a woman (wife) to become pregnant and average is 8.82 months (Handayani, 2010). give birth to a living child of a male partner DMPA injection contraceptives are a type of (husband) who can conceive it. contraceptive that only contains progestin. Long Return of Fertility in Mothers Besides, DMPA there is one more type of Post-Acceptance of Injectable Birth Control contraceptive containing progestin, namely and Implants in Public Health Centre Depo enanthate (Depo Baumata Kupang Regency. Based on Mann- Noristerat). DMPA type injectable birth Whitney test obtained, there is a difference control contains 150 mg of DMPA, which is in the length of fertility return in mothers administered every 3 months by Post Acceptance Kb Injectable and Implant. intramuscular injection (in the buttock

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area), while the Type Depo Noristerat bleeding does not raise blood pressure and contains 200 mg of norethindrone is very effective for mothers who should not enanthate, administered every 2 months by use drugs containing estrogen intramuscular injection (Saifuddin, 2003). (Wiknjosastro, 2014). The mechanism of The way DMPA works is to prevent implantation is that it can suppress ovulation, thicken cervical mucus to ovulation, make the cervical sap viscous, decrease sperm penetration ability, make making the endometrium unprepared for the mucous membranes of the uterus thin pregnancy. With the concept of its work is and atrophy, inhibit the transportation of progesterone can block the production of LH gametes by the tuba. The effectiveness of so that there is no ovulation and because the injectable contraceptives DMPA has high endometrial situation is not ready to be a effectiveness, with 0.3 pregnancies per 100 place of implantation. women-years, as long as the injection is Based on Table 4.8 the average carried out regularly according to a fertility return on post-acceptance KB predetermined schedule (Saifuddin, 2003). Implant was 3.05 months. Hormones Based on table 4.7, the average return contained in kb implants can prevent of fertility in post-injectable kb acceptance is pregnancy by inhibiting the journey of 7.65 months. This following other opinions sperm to meet with the egg, inhibiting the that state the limitations of DMPA release of the egg, and preventing the contraceptives are often found menstrual implantation of the ovum in the uterus. After disorders, clients are very dependent on the taking off the implant, the body needs to place of health care facilities (must return adapt to changes in hormone levels to return for injections), cannot be stopped at any to the state before using the implant. It time before the following injections, weight usually takes 1-3 months for fertility to problems are the most common side effects, return (Baziad, 2010). Besides, implant does not guarantee protection against contraceptive use can also affect fertility, transmission of sexually transmitted and it can even last for months or years infections, hepatitis B virus, or HIV (Previyanti, 2017). Meanwhile, another infection, and late return of fertility after opinion states that the use of implant cessation of use, late return of fertility not contraceptives to restore fertility rates is because of damage/abnormalities in the quite fast after removal (Saifuddin, 2010). genitalia organs, but rather because of the Based on the above discussion, it can endless release of injection drugs from the be concluded that the Long Return of depot (injection site), changes in serum Fertility in Mothers Post Acceptance of lipids in long-term use, in long-term use can Injectable Birth Control with Implants in slightly decrease bone density (density), in Baumata Health Center Kupang district long-term use can cause vaginal dryness, Based on research with Mann-Whitney test decreased libido, emotional disorders (rare), obtained there is a difference in the length of headaches, nervosity, acne (Saifuddin, fertility return in mothers Post Acceptance 2003). Injection and Implant contraceptive. Implant is a contraceptive inserted The research also showed that the into the skin, which has fairly high average return of fertility in post-injectable effectiveness, and is a long-term birth control acceptance was 7.65 months, contraceptive 3 years and the effect of milder while the average fertility return in post-

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acceptance Implant contraceptive was 3.05 https://www.- months. This research is expected to be used researchgate.net/publication/323574 as a source of information for researchers to 631_Perbedaan_Lama_Waktu_Kemb develop further research. Further research ali_Hamil_pada_KB_Suntik_1_Bula can be done by paying attention to the n_dengan_KB_Suntik_3_Bulan_di_ control of disruptive factors, the expansion Wilayah_Kerja_Puskesmas_Daya_M of samples so that more significant results urni_Kabupaten_Tulang_Bawang_B can be obtained and can be used as a arat_Lampung/link/5a9e96a90f7e9b comparison material to conduct other or 80dfb4e47b/download. similar studies. Hartanto (2020). Keluarga Berencana dan Kontrasepsi. Jakarta: Pustaka Sinar REFERENCES Harapan. Affandi (1987). Kontrasepsi Keluarga Manuaba (2010). Memahami Kesehatan Berencana, Ilmu Kebidanan. Jakarta: Reproduksi Wanita. Jakarta: EGC. Yayasan Bina Pustaka Sarwono Mulyani dan Rinawati (2013). Keluarga Prawihardjo. Berencana dan Alat Kontrasepsi. Baziad (2010). Kontrasepsi Hormonal. Yogyakarta: Nuha Medika. Jakarta: Yayasan Bina Pustaka. Previyanti (2017). Berapa Lama Kembalinya Depkes R (2013). Laporan Nasional Riset Kesuburan Setelah Lepas KB Implant, Kesehatan Dasar. Jakarta: Pusat Alodokter. Available at: Penelian Pengembangan Kesehatan. https://www.alodokter.com/komuni- Dinas Kesehatan Nusa Tenggara Timur tas/topic/pakai-kb-imlan. (2017). Profil Kesehatan Provinsi Nusa Saifuddin (2003). Buku Panduan Praktis Tenggara Timur Tahun 2017. Kupang: Pelayanan Kontrasepsi. Jakarta: Dinas Kesehatan Nusa Tenggara Yayasan Bina Pustaka. Timur. Saifuddin (2010). Buku Panduan Praktis Handayani D (2010). Hubungan Lama Pelayanan Kontrasepsi. Jakarta: Pemakaian Kontrasepsi DMPA Yayasan Bina Pustaka. dengan Kembalinya Kesuburan pada Sulistyawati (2014). Pelayanan Keluarga Post Akseptor KB Suntik DMPA. Berencana. Jakarta: Salemba Medika. Journal Online. 1. Available at: Wiknjosastro (2014). Ilmu Kebidanan. Jakarta: Yayasan Bina Pustaka.

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