The use of Method Information Index (MII) to monitor the amount of information given to women users of modern contraceptives in Indonesia: results from an analysis of the 2007, 2012 and 2017 demographic and health surveys.

BACKGROUND: The use of Method Information Index (MII) indicates whether women contraceptive users receive adequate information about all available contraceptive methods, side effects of the methods, and how to deal with the side effects if experienced-at method initiation. OBJECTIVE: This study aims to investigate the level of MII scores or the amount of information received by married women users of five modern contraceptives at the time of initiation and changes of its determinants based on the Indonesian Demographic and Health data between 2007 and 2017. METHODS: Data of married women who used most common five modern contraceptive methods (the pill, injectables, implants, IUD, and female sterilization), comprised of a total unweighted sample of 35,412 users out of the 32,895; 45,607 and 49,627 women aged 15-49 in the 2007, 2012, and 2017 Indonesian Demographic and Health Survey (IDHS), respectively. The Method Information Index (MII) scores were calculated based on responses to three questions (whether women were told about method-specific side effects, advised what to do if they experienced them, and informed about other available methods). Multivariable logistic regressions with 'time' as an interaction variable were used to assess the influence of time upon the MII scores and its determinants. RESULTS: The MII scores were 23.84% in 2007, 24.60% in 2012 and 28.65% in 2017. Obviously, over 70% of reproductive-age women contraceptive users were not receiving complete information about modern contraceptives at the time of initiation. After 5 years (2012), only living in the Java Bali region (AOR = 1.34, 95% CI 1.09-1.66) compared to living in other islands, and currently using injectables (AOR = 1.43, 95% CI 1.10-1.87) and currently using implants (AOR = 1.68, 95% CI 1.07-2.63) compared to currently using pills had significantly higher odds of receiving MII information. After 10 years (2017), only one variable (the 'richest' in the wealth quintile category (AOR = 0.70, 95% CI 0.50-0.99) compared to the 'poorest') still showed a significant association with receipt of complete MII information. CONCLUSIONS: Despite the fact that the MII scores increased gradually across the years, interaction with 'survey time' showed that the likelihood of receiving complete MII information was not statistically different in the 5 years (2007-2012) and in the 10 years (2007-2017) period from the reference category in 2007. The authors recommend use of the MII score as an objective measure to evaluate access to MII essential information and to monitor an increase in the informed population in Indonesia.

Attempts to purchase misoprostol online in Indonesia: a mystery client study design.

BACKGROUND: Abortion is highly restricted in Indonesia; self-administered misoprostol can safely induce an abortion. Brick and mortar pharmacies, a common place to purchase misoprostol off-label in other parts of the world, are monitored closely by the government authority in Indonesia which controls drugs so that they cannot function outside the law without risking arrest and prosecution. An online marketplace has sprung up in response that sells misoprostol through in-country distributors. Such procurement offers a level of safety and anonymity to the buyer and seller. So as to understand online access to misoprostol, we created a protocol to identify the most visible universe of sellers. METHODS: We carried out a mystery client methodology to replicate the experiences of women procuring misoprostol online. Our study consisted of five stages: (1) identify the universe of online sellers using the most common search terms, drawn from multiple platforms to capture diversity in interactions as well as products sold (2) remove duplicates across sites as determined by their telephone numbers (3) draw a roughly probability proportional to size sample (4) contact sellers as mystery clients through text/chat, depending on the platform, and engage with them and (5) attempt to purchase drugs offered by the seller. Descriptive statistics are presented. RESULTS: The listing generated 727 sites: 441 websites, 153 marketplace sellers, and 133 Instagram profiles. After removing duplicate listings, we identified 281 unique sellers. We selected all sellers with greater than 12 listings, 60% of sellers with 4-12 listings, 50% of sellers with 2-3 listings, and 40% of sellers with only one listing. Mystery clients were able to send initial messages to 110 sellers, of which 16 never responded. The interaction progressed to purchasing misoprostol with 76 sellers, 64 of whom sent drugs. CONCLUSIONS: As women seek to terminate unwanted pregnancies in legally restrictive settings, online sales of misoprostol must be considered. With the Covid pandemic constraining movement, the importance of this way of procuring misoprostol will likely become more appealing. Understanding this unregulated landscape is important if we are to try to improve women's ability to safely conduct an abortion in highly restrictive settings.

Building on health security capacities in Indonesia: Lessons learned from the COVID-19 pandemic responses and challenges.

As an active member country of the WHO's International Health Regulation and Global Health Security Agenda, Indonesia, the world's fourth-most populous and largest archipelagic country has recorded the second-highest COVID-19 cases in Asia with over 1.8 million cases in early June 2021. This geographically and socially diverse country has a dynamic national and sub-national government coordination with decentralized authorities that can complicate a pandemic response which often requires nationally harmonized policies, adaptability to sub-national contexts and global interconnectedness. This paper analyses and reviews COVID-19 public data, regulations, guidance documents, statements and other related official documents to present a narrative that summarizes the government's COVID-19 response strategies. It further analyses the challenges and achievements of the country's zoonotic diseases preparedness and responses and lastly provides relevant recommendations. Findings are presented in four sections according to the Global Health Security Agenda capacities, namely epidemiological surveillance (detect capacity); laboratory diagnostic testing (respond capacity); data management and analysis (enable capacity); and the role of sub-national governments. The COVID-19 pandemic has been a catalyst for the rapid transformation of existing surveillance systems, inter-related stakeholder coordination and agile development from the pre-pandemic health security capacities. This paper offers several recommendations on surveillance, laboratory capacity and data management, which might be useful for Indonesia and other countries with similar characteristics beyond the COVID-19 response, such as achieving long-term health security, zoonoses and pandemic prevention, as well as a digital transformation of their governmental capacities.

Pregnancy resumption following contraceptive discontinuation: Hazard survival analysis of the Indonesia Demographic and Health Survey Data 2007, 2012 and 2017.

OBJECTIVE: The objective of this research is to estimate the probability of pregnancy resumption after discontinuing reversible contraceptives-pills, injectables, implants and IUDs, and to examine the factors associated with the resumption of fertility. METHOD: The study uses pregnancy calendar data from Indonesia Demographic and Health Surveys (IDHS) of 2007, 2012 and 2017. A hazard model survival method is used for estimating the time needed to resume pregnancy since discontinuing reversible contraceptives. Retrospective data on 4,573; 5,183 and 5,989 episodes of reversible contraceptive discontinuation at the three surveys respectively have been analysed. RESULTS: This study shows that women regained fecundity within one year of discontinuing IUD, pill, injectables or implants. Women using IUD could resume their pregnancy faster than those using implants, pills and injectables. Over the three IDHS 2007, 2012 and 2017 the age-specific percentages of women becoming pregnant after one year of contraceptive discontinuation vary between 72 and 85 for IUD, 75 and 81 for pills, 72 and 76 for implants and 64 and 67 for injectables, with the percentages being higher among younger women. The analysis further shows that length of contraceptive use, parity, prior sexually transmitted infections, knowledge of fertile period, household wealth status and place of residence have no impact on occurrence of pregnancy after contraceptive discontinuation. CONCLUSION: The analysis disproves a myth that reversible contraceptives make women infertile. Depending on the type of reversible contraceptive used, 65% to 85% of the women were able to conceive after one year of discontinuation.

Online Abortion Drug Sales in Indonesia: A Quality of Care Assessment.

This study sought to understand the experience of buying misoprostol online for pregnancy termination in Indonesia. We conducted a mystery client study August through October, 2019. Interactions were analyzed quantitatively and qualitatively, along with the contents of the packages. One hundred ten sellers were contacted, from whom mystery clients made 76 purchases and received 64 drug packages. Almost all sellers sold "packets" containing multiple drugs; 73 percent of packets contained misoprostol, and 47 percent contained at least 800 mcg of misoprostol. Thirty-four packets contained insufficient drugs to complete an abortion. When compared to WHO standards, 87 percent of sellers imparted incomplete information about potential physical effects; no seller provided information about possible complications. Women buying misoprostol from informal online drugs sellers will be underprepared for understanding potential side effects and complications. Educational activities are needed to increase women's access to information about safe use of misoprostol as a harm reduction strategy.

Survey-based data describing readiness to adopt an electronic pregnancy registration-monitoring system amongst health workers.

Electronic Health (eHealth) systems show a growing trend in developing countries to enhance their respective healthcare services. However, there is a lack of empirical study regarding readiness during preparation for eHealth implementation in Primary Health Care (PHC) units, specifically for antenatal care health workers who serve not only for personal care but also community services. The survey-based data applied in this research describes the assessment of the pre-implementation of the Electronic Pregnancy Registration and Monitoring System amongst health workers who involved in ANC services in primary health care (PHC) units of South Tangerang district, an urban area of Banten Province, Indonesia. Primary data was collected from 210 ANC health workers who work in 6 PHCs of the district. The data consists of socio-demographic factors of respondents such as age, education, years of experience etc., and captures individual responses to measure their readiness for eHealth adoption. The availability of this data will provide valuable information for researchers, healthcare organisations and government as the policy makers to prepare strategies with regard to readiness for eHealth adoption amongst health workers in PHCs.

Narrative Review for Exploring Barriers to Readiness of Electronic Health Record Implementation in Primary Health Care.

OBJECTIVES: The aim of this study is to explore the enabling factors associated with readiness in Electronic Health Record (EHR) implementation and to identify the barriers related to readiness regarding the situation of primary health cares in developed and developing countries. METHODS: A narrative review of open-source literature was conducted using the ProQuest, ScienceDirect, MEDLINE, and PMC databases to identify the enabling factors and barriers to EHR readiness. The keywords applied were 'electronic health record', 'readiness', 'primary health care', and 'primary care'. RESULTS: Some barriers were found that may affect readiness, specifically individual barriers and organizational barriers. In developing countries, organizational barriers such as a lack of skilled manpower, insufficient senior management, and a lack of interaction among team members were the common barriers, while in developed countries individual barriers such as unfamiliarity with new systems and a lack of time to use computers were frequently found as barriers to readiness. CONCLUSIONS: This study summarized the enabling factors and barriers with regard to EHR readiness in developed and developing countries.

Receiving voluntary family planning services has no relationship with the paradoxical situation of high use of contraceptives and abortion in Vietnam: a cross-sectional study.

BACKGROUND: Vietnam shows a paradoxical situation where high contraceptive prevalence goes together with high abortion rates. This study examined the associations between self-reports of having received voluntary family planning (VFP) services and induced abortions. METHODS: A cross sectional survey was conducted in Thai Nguyen province, covering a total of 1281 women. Data were derived from a sample of 935 married women aged 18-49 years who were ever-users (93.5%) and current users of contraceptives (84%), and had completed birth histories. The dependent variables were the likelihood of having an induced abortion and repeated (two or more) induced abortions. The main independent variable was having received the three VFP dimensions (counselling, broader information, and access to availability). The association was examined using multivariate logistic regressions, taking into account women's socio-demographic characteristics. RESULTS: The overall induced abortion percentage was 19.4 per 100 pregnancies. None of the three VFP dimensions was significantly associated with the odds of having an induced abortion or having repeated induced abortions. Mother's age of 35 or older, having more than three living children, and ever used female contraception methods significantly doubled or more the odds of having an induced abortion and significantly tripled the odds of having repeated abortions. CONCLUSIONS: Results indicate that women receiving VFP services were not less likely to have induced abortions. The provision of family planning counselling, information on contraceptive method mix, and management skills to ensure availability, are in need of reinforcement in a new set of policy and program strategies in the future.