Data released by the National Population and Family Planning Board (BKKBN) show that unmet need accounts for 75% of the causes of maternal mortality in Indonesia and affects population growth.1 One of the issues that has become the focus of the government is the tendency of the high number of unmet need since it affects the family planning program. High number of unmet need is the cause of high Total Fertility Rate (TFR) and unwanted pregnancy.2–4 Unmet need certainly has an impact on abortion because of unwanted pregnancy, short interpregnancy interval, too many pregnancies, as well as complications of disease during pregnancy, difficulty during labor, and puerperal complications.5–7 Report on the results of unmet need is very important to get an overview of the achievement of the family planning program and to find out the state of the untapped targets.8–10 By knowing the proportion of these groups, the size of the potential targets that still need to be invited for family planning will be found.11,12

The above findings support a notion that the high number of unmet needs causes a high fertility rate, which can lead to an increasingly large and uncontrolled number of births.13 Indonesia is one of the developing countries with a large population.14–16 Another impact caused by unmet need for family planning is Maternal Mortality Ratio (MMR) which continues to increase. Although it has decreased, from 359 per 100,000 live births in 2012 to 190 per 100,000 live births in 2013, MMR in Indonesia is still considered high. It is because the MMR has not been able to achieve MDGs target in 2015, which is 102 per 100,000 live births.17

Furthermore, in Central Sulawesi Province, the number of unmet needs reached 11.5%, which consisted of 117,954 people who wanted to space their pregnancies, but they did not use contraceptives. There were also 70,825 people who did not want children anymore, but they did not use contraceptives.17–20

Districts or cities with the highest number of unmet needs in Central Sulawesi in 2019 include Sigi Regency (21.1%), Toli-toli (18.5%) and Banggai Laut (18.2%). Referring to the national target (17.5%), Sigi Regency is still in the high category.19 Data from the Sigi Regency Health Office, Central Sulawesi, shows that the number of couples of reproductive age who were not on family planning has increased every year (21% in 2018 and 22.1% in 2019).19

Based on data from the Population Control and Family Planning Office of Sigi Regency in 2019, Marawola sub-district has the highest number of couples of reproductive age who were not on family planning (995 people). Based on these data, the researchers were interested in examining “The factors associated with the incidence of unmet need for family planning in couples of reproductive age in the working area of Marawola Health Center, Sigi Regency, Central Sulawesi”. Variables studied included age, education, history of contraceptive use, and husband's support.

This research is an analytic observational study with a cross-sectional study design which was conducted to see the relationship between independent variables (age, education, family planning history, and husband's support) and dependent variable (unmet need for family planning). This research was conducted on September 9–19, 2020 in the working area of Marawola Health Center, Sigi Regency, Central Sulawesi Province. Data were collected using a questionnaire which were analyzed using univariate and bivariate analysis utilizing Chi-Square test. Population in this study were 4715 couples of reproductive age in the working area of Marawola Health Center. By using Lemeshow's calculation technique and simple random sampling, a sample of 90 people was obtained. Samples were respondents who met the following inclusion criteria:

• 1.

  Respondents were couples of reproductive age.

• 2.

  Respondents were couples of reproductive age who were on family planning and who were not on family planning.

• 3.

  Respondents were willing to be interviewed and could speak Indonesian.

The distribution of characteristics of respondents according to age, family planning history, husband's support, unwanted pregnancy, fertility, and unmet need can be seen in Table 1.

Table 1 shows that there are 50 respondents (55.6%) with a non-ideal reproductive age (>35 years) and 40 respondents (44.4%) with an ideal reproductive age (20–35 years). Moreover, there were 20 respondents (22.2%) who had had family planning, and 70 respondents (77.8%) who had never had family planning. Additionally, there were 20 respondents (22.2%) who received support from their husbands for using contraceptives, while the remaining 70 respondents (77.8%) did not receive support from their husbands to use contraceptives. There were 50 respondents (55.6%) with a low level of education and 40 respondents (44.4) with a high level of education. In addition, there were 55 respondents (61.1%) with unmet need and 35 respondents (38.9%) with met need.

Results of the analysis using Chi-Square carried out on age and the incidence of unmet need for family planning obtained p value of (0.004)≤α (0.05). Thus, H0 in this study was rejected which indicates that there was a relationship between age and the incidence of unmet need for family planning. It is in line with the research assumption that there is a relationship between age and unmet need. This is very likely due to the large number of respondents who had early marriage so they do not understand the importance of family planning.21,22 They also do not have sufficient knowledge on the impact of not using contraceptives.

The results of this study are in line with research conducted by Nurjannah (2017) which obtained p=0.000, less than α=0.05. It showed that there was a relationship between age and the incidence of unmet need.23 Age is one of factors influencing the incidence of unmet need.24–26 Besides, a research conducted by Osterlund et al. (2016) found that age is a factor in unmet need for family planning, because the higher the age, the higher the woman's need for contraception.27,28

Moreover, results of the analysis conducted using Chi-Square on education and the incidence of unmet need for family planning obtained p value of (0.005)≤α (0.05). Thus, H0 in this study was rejected, which means that there was a relationship between education and the incidence of unmet need for family planning. According to the researchers’ assumptions, this can happen because the education that a person is undergoing has an influence on increasing thinking skills. In other words, someone with a higher education will be able to make better decisions than someone with a lower level of education. A good education provides broad insights so that the understanding process can run well.

Couples of reproductive age with a high level of education can better receive knowledge about Unmet Need.29,30 This is consistent with the modification between Anderson's (1974) and Lawrence Green's theoretical framework which claimed that education is included in a predisposing factor, one of the factors that can strengthen human behavior.2 In this case, the behavior referred to is the use of contraceptives in order to reduce the incidence of unmet need for family planning.31–33

More importantly, results of the analysis using Chi-Square carried out on family planning history and the incidence of unmet need for family planning obtained p (0.003)≤α (0.05). Thus, H0 in this study was rejected, which means that there was a relationship between family planning history and the incidence of unmet need for family planning. Based on the researchers’ assumptions, it can happen because of the side effects of past contraceptive use. In addition, those who decided not to use contraceptives were afraid of its effects as a result of not understanding its benefits.

The results of this study are in line with a research which obtained p=0.027, less than α=0.05. It shows that there is a relationship between family planning history and the incidence of unmet need for family planning because of the fear of the acceptors. It is also supported by a research, it is known that p value≤α (0.001≤0.05), which means that there is a relationship between family planning history and the incidence of unmet need for family planning.34,35

Results of the analysis using Chi-Square carried out on husband's support and the incidence of unmet need for family planning obtained p value of (0.002)≤α (0.05). Thus, Ho in this study was rejected, which means that there was a relationship between husband's support for family planning and the incidence of unmet need for family planning. Based on the researchers’ assumptions, it occurs since the husband is dominant in making decisions. Gender disparities are very common in women's reproductive health issues.

Husband's support in this study is the extent to which the husband is involved in supporting the wife's decision to use contraceptives, such as reasons for choosing contraceptives, determining the number of children, monitoring the rules for using contraceptives, monitoring side effects, looking for other alternatives if the contraceptive method used is not satisfactory, and willing to use contraceptives in accordance with the wife's condition.31,36–38

Based on the results of the study and discussion, this study concludes that there is a significant relationship between age, education, family planning history and husband's support for family planning with the incidence of unmet need for family planning in couples of reproductive age in the working area of Marawola Health Center. Women of reproductive age who have husbands who do not support family planning tend to experience unmet need for family planning.

The authors declare no conflict of interest.