Husband's knowledge of the use of LARC
The results of the research on statistical test analysis showed that the p value = 0.330, and this indicates that there is no relationship between the husband's knowledge and the use of LARC in the Special Region of Yogyakarta. Then from 36 respondents who had less knowledge, most of them used LARC as many as 25 respondents with a percentage (69.44). The closeness analysis of the two variables obtained an OR value of 1.70 (95% CI = 0.57–5.08), meaning that respondents with good knowledge had 1.70 times the chance to use LARC compared to husbands who had less knowledge.
Knowledge in this study is knowledge possessed by husbands related to contraception, namely the benefits of various contraceptives, side effects, and effectiveness of contraceptives. The results of this study are in line with research conducted by Nurlilis and Winda (2016) on the effect of the desire of fertile age couples in the use of LARC, with the results that some respondents have good knowledge, non-LARC is lacking, showing p value = 0.702 which means there is no relationship meaningful between the level of knowledge and the use of LARC. In theory, knowledge is a very important domain for the formation of one's behavior. If a person's behavior change is based on knowledge, the behavior is expected to last a long time and be permanent (Nurul and Nurhabibah 2018). This theory implies that the level of knowledge is not always in line with behavior (providing behavior change), because behavior changes itself require a long learning process.
According to the researcher's analysis, based on the results at the level of education, it shows that most of the respondents have a low education of 74.65%, so it greatly affects the respondent's knowledge because someone's knowledge can influence the decision-making process and behavior changes to accept something new such as the use of contraception. In theory, education is an effort of persuasion or learning to people to take actions in overcoming problems and improve their health. This change in health care is generated by education based on knowledge and awareness through the learning process (Nurul and Nurhabibah 2018). This theory implies that if the resulting education is low, knowledge will also be low so that it cannot provide behavior change in improving and overcoming health problems, in this case the behavior of using LARC.
One way to increase knowledge is health education. Previous research (Nurul and Nurhabibah 2018) states that someone's knowledge is the result of knowing, which occurs from the result of sensing a certain object. One persistent barrier is misinformation about the safety and availability of LARC, especially for teens (Aligne et al. 2020).
Misinformation on husband also plays a key factor for not using contraception (Herbert 2015), but this was not shown to be significant in this study. It is possible that in addition to misinformation on husbands, there are other factors that also influence the choice of contraception, namely husband dominance in decision-making, and opposition opinions between husband and wife (Herbert 2015). Therefore, it is necessary for health workers, especially to provide counseling to husbands, not only to wives, so that public knowledge can be broad.
Husband's attitude towards using LARC
The results of the statistical test analysis obtained p value > 0.05, namely 1,000, which means there is no relationship between husband's attitude and use of LARC. The closeness analysis of the two variables obtained an OR value of 0.98 [0.18–4.41] meaning that respondents with an agreeable attitude were 0.98 times to use LARC contraception compared to husbands who agreed, and in the adjusted results it was found that husbands who had an agreed attitude had 1.44 times the chance to use LARC. It was statistically not significant compared to husbands who disagree.
Based on the results of previous research, most of the respondents had a good attitude and chose non-hormonal LARC, namely 55.69% because most respondents in this study had a good attitude due to positive respondents' trust, but if the respondents' trust was negative, it could cause negative attitude too. The Chi-square test value was p = 0.027, which means that there is a relationship between attitude and non-hormonal LARC selection. The OR results obtained a value of 2.041, which means that respondents with a good attitude 2.041 times to choose non-hormonal LARC were compared with respondents who had a bad attitude (Nurlilis and Winda 2016).
In theory, attitude is a person's closed response to certain objects, which involves opinion factors (agree–disagree, good–bad, and so on) (Nurul and Nurhabibah 2018).The meaning of this theory is that the husband's participation is needed both in the form of a response that involves opinion factors that can help the wife in choosing the contraceptive method to be used. The results of research conducted by Nurul (2016) show that the husband's attitude can be influenced by education, occupation, age, and sources of information. Based on the theory (Syarifah 2016), the level of education determines the family planning pattern and the basis for contraceptive use. Therefore, if education is low, knowledge will also be narrow so that the husband's attitude in participating in determining family planning decreases. The results of this study indicate that the majority level of respondent education is in a low level of education of 74.65%, and this is very influential on the husband's attitude in responding to giving an opinion in helping his wife to determine which contraception to use.
In the form of patriarchal society, on the previous research (Mattebo et al. 2016) it shows that traditionally, the man is in charge on making decisions regarding to family planning. However, women are not autonomous. On several occasions, a woman may be disagree with the husband attitude towards family planning and denied the use of contraceptives by her husband. This can happen because of the women empowerment. More empowered women who more able to make household decision based on her own and joint household decisions with husband are more likely to use either short-term or LARC methods rather than not using contraception at all (Ings 2017).
Husband's support with the use of LARC
Husband support in family planning is a characteristic given during an ongoing relationship with his wife, such as the participation of men in supporting their wives to participate in the family planning program, not only taking their wives to health services or simply facilitating with financial materials but also accompanying their wives during installation contraception and family planning counseling (Sumartini and Indriani 2016).
The results of the statistical test analysis showed that the p value = 0.26, and this indicates that there is no relationship between husband's support and the use of LARC in the Province of Yogyakarta Special Region. The closeness analysis of the two variables obtained an OR value of 1.35 [0.36–5.68] meaning that respondents who supported their wives were 1.35 times more likely to use LARC compared to husbands who did not support their wives, and in the adjusted results it was found that husbands who supported their wives had 1.17 times chance to use LARC compared husbands who do not support their wives are not statistically significant.
Husband's support is very important to encourage wife's interest in family planning. Therefore, wives should get comfort in using contraception which is obtained from family support, especially from husbands. The husband is the holder of power in the family in making decisions for the wife in family planning. Husband does not support because of low knowledge. The results of this study indicate that the majority of husbands have low knowledge as many as 25 respondents with a percentage (69.44) due to the lack of support from their husbands and less participation of husbands in family planning, unwilling to take their wives to health service and low economic conditions so they are unable meet in terms of financial material such as money. However, some of the husbands who have low knowledge do participate in family planning, by taking advantage of various free programs provided by the government to regulate the number of children (Sri et al. 2016).
This study is in line with research conducted by Notostmodjo (2010). The results of the Chi-square test obtained a value of = 0.835, indicating that there is no relationship between husband's support and the selection of non-hormonal LARC. This study explains that the husband's perception of LARC on family planning knowledge is still wrong, with the results of the interview about the complaints of side effects felt by the wife in using LARC which is now considered normal; when the wife uses the IUD, then vaginal discharge occurs, and the husband thinks that the discharge occurs because it is caused by a side effect of the IUD, even though the relationship is related to cleanliness, not a side effect of the IUD and some say that when his wife uses the IUD, when having sex, the husband's reproductive organ (penis) feels like being pricked by a needle. From the results of the interview, it was found that most husbands did not get information about LARC, which led to low knowledge and advised their wives not to use LARC. Therefore, health workers can provide counseling to husbands to increase knowledge so that husbands can improve communication with wives through exchanging information with each other and can provide support to wives and that this counseling can increase husbands' knowledge about family planning.
This study shows that husband is not significantly involved in the selection of LARC. Based on previous studies (Bharadwaj et al. 2012), three important factors on choosing a contraceptive methods are high efficacy, availability of protection against sexual transmitted disease, and non-interference with sex activity. In the other hands, the possibility of altering the menstrual pattern, and reversibility were not considered important. Therefore, it is very possible that husband is not an important factor in choosing contraception.