factors affecting vasectomy contraception abstract intisari - Zenodo

Indrayani, Khonita Hikmala Fatma, & Bony Wiem Lestari

Hal. 27-36

FACTORS AFFECTING VASECTOMY CONTRACEPTION FAKTOR-FAKTOR YANG MEMPENGARUHI PEMILIHAN KONTRASEPSI VASEKTOMI Indrayani1, Khonita Hikmala Fatma1, Bony Wiem Lestari2 1Akademi

Kebidanan Dewi Sartika, Jl. Terusan Kopo KM 12,8 Katapang, Bandung, Telp./Faks.+6225880535 Epidemiologi dan Biostatistik Fakultas Kedokteran Universitas Padjadjaran, Jl. Raya BandungSumedang km 21, Bandung, Telp./Faks. (022) 7795594 Corespondence address: [email protected]

2Departemen

ABSTRACT Background: The low participation of men in family planning is influenced by many factors, including demographic factors, social structure factors, family factors, and the availability of health resources. There are many other factors that influence the selection of contraceptive vasectomy is not yet known. Objective: To know factors affecting vasectomy contraception in Kiarapedes, Purwakarta regency. Method: The study design used was mixed methods approaches and strategies embedded concurrent. Quantitative data were collected by questionnaire. The gathering of qualitative in-depth interviews were conducted in the respondent, the respondent's wife and PLKB selected using an interview guide. The data has been collected and analyzed, for a quantitative method using descriptive analysis of the characteristics of respondents. For qualitative methods, information from research subjects are recorded in the form of transcripts, then given coding and grouped into categories and themes. Result: Based on data collected from 53 respondents found the majority of respondents were in the age group 41-50 years (39.6%), most of the respondents had a number of children >3 people (75.5%), the majority of respondents had elementary (90, 6%), all Muslim respondents (100%), most of the income ≥ minimum wage (75.5%) of all respondents have the support of his wife (100%), and most respondents receive information from field officers (73.6% ). Response acceptors of stigma related to religious factors, sexual, and psychological medical treatment while the reasons respondents chose vasectomy because of factors such as family, economy and role model. Conclusion: Modeling is another factor that can influence a man's decision to undergo a vasectomy in the village Kiarapedes. Keywords: Family planning, vasectomy

INTISARI Latar belakang: Rendahnya partisipasi pria dalam keluarga berencana dipengaruhi oleh banyak faktor, di antaranya faktor demografi, faktor struktur sosial, faktor pasangan, dan faktor ketersediaan sumber daya kesehatan. Masih banyak faktor lain yang mempengaruhi pemilihan kontrasepsi vasektomi yang belum diketahui. Tujuan: Untuk mengetahui factor-faktor yang mempengaruhi pria dalam pemilihan vasektomi di Kiarapedes, Kabupaten Purwakarta. Metode: Rancangan penelitian yang digunakan adalah mixed methods dengan strategi concurrent embedded. Data kuantitatif dikumpulkan dengan kuesioner. Untuk pengumpulan data kualitatif dilakukan wawancara mendalam pada responden, istri responden dan PLKB yang terpilih dengan menggunakan panduan wawancara. Data yang sudah dikumpulkan kemudian dianalisis, untuk metode kuantitatif menggunakan analisis deskriptif terhadap karakteristik responden. Untuk metode kualitatif, informasi dari subjek penelitian dicatat dalam bentuk transkrip, kemudian diberi koding dan dikelompokkan menjadi kategori serta tema. Hasil: Berdasarkan data yang terkumpul dari 53 responden didapatkan sebagian besar responden berada pada kelompok umur 41-50 tahun (39,6%); sebagian besar responden memiliki jumlah anak >3 orang (75,5%); mayoritas responden berpendidikan SD (90,6%); seluruh responden beragama Islam (100%); sebagian besar berpenghasilan ≥ UMR (75,5%); seluruh responden mendapatkan dukungan dari istri (100%); dan sebagian besar responden mendapatkan informasi dari PLKB (73,6%). Tanggapan akseptor terhadap stigma berkaitan dengan faktor agama, seksual, tindakan medis dan psikologi sedangkan alasan responden memilih vasektomi diantaranya karena faktor pasangan, ekonomi dan panutan. Simpulan: Panutan merupakan faktor lain yang dapat memengaruhi keputusan pria untuk menjalani vasektomi di Desa Kiarapedes. Kata kunci: Faktor, keluarga berencana, vasektomi

Jurnal Ilmu Kebidanan, Volume 1, Nomor 1, Maret 2013  27


INTRODUCTION

Hal. 27-36

problems resulting from vasectomy. We

Indonesia is the 5th most populous

aimed to explore the characteristics of

country in the region of the Association of

vasectomy clients and identify factors which

South East Asian Nations (ASEAN), and

may influence the selection of vasectomy in

was ranked the 8th most populous in the

men.

South East Asia Region (SEARO).

1-2

The

growth of population in Indonesia is 5 years faster than projected by the Central Bureau

RESEARCH METHODS In this study, we used a mixed methods

of Statistics (BPS).3 The uncontrolled growth

using

of Indonesian population will cause many

Concurrent embedded was done through

problems.1,4 Family Planning programme

quantitative and qualitative data collection at

(KB)

the same time. Quantitative data were

is

one

attempt

from

Indonesian

government to control its population growth. The low participation of men in family

concurrent

embedded

approach.

collected by questionnaire. For qualitative data, the information was collected through

planning is influenced by many factors,

in-depth

including demographic factors (age, number

respondents

of children and sex of the child), social

Obtained information from qualitative study

structure

science,

used to support the quantitative data and

religion, socio-economic status and level of

explore other factors that influence the

well-being), factor family (wife’s health and

selection of vasectomy. Data collection was

wife support), and the availability of health

conducted

resources (health insurance, access to

Purwakarta District in October 2012.

factors

(education,

interviews using

in

among an

the

interview

Kiarapedes

selected guide.

Village,

information, distance to health facilities and

Subjects were vasectomy clients that met

health workers). Research showed that

inclusion criteria and agreed to become

there is a relationship between knowledge

respondents.

and wife support with male participation in

(informed consent). The inclusion criteria

family planning. In addition, education and

are: vasectomy clients, age more than 30

knowledge also affect the decision making in

years, residing in the Kiarapedes Village.

the selection of contraception methods.5-7

We excluded men who become vasectomy

There are many other factors that

clients

to fill out the consent form

because

of

his

wife’s

health

influence the selection of vasectomy which

condition. Before data collection, all subjects

are not yet known. It is important to identify

receive complete explanation about this

such factors, because they may affect male

study. Those who were agreed then fill in the

in choosing vasectomy. It is also beneficial

written consent. For quantitative research,

for health and family planning field workers,

we collected 53 subjects using simple

so they can provide services that meet the

random sampling technique. The data was

client’s

further analyzed using descriptive statistics.

needs

and

anticipate

possible



Meanwhile, qualitative data were written into transcripts and by doing peer briefing we classified

the

information

into

certain

categories and themes. RESULTS AND DISCUSSION We collected data from 53 respondents. The

result

showed

that

majority

of

respondents were in the age group of 41-50 years (39.6%), most respondents had a number of children> 3 people (75.5%), those with elementary education level (90.6 %); they have Moslem religion (100%), most of the income ≥ minimum wage (75.5%), all respondents have the support of his wife (100%),

and

most

of

them

received

information from field officers (73.6%). Most respondents were in the age group of 41-50 years (39.6%), this is in accordance with the theory and research stating that age

Hal. 27-36

Table 1 Subject Characteristics towards The Choosing of Vasectomy Vasectomy acceptor (n = 53) f %

Variable

Age  31-40 years  41-50 years  51-60 years  61-70 years  71-80 years Number of children  1  2  >3 Level education  Elementary school  Junior high school  Senior high school  Higher education Religion  Islam  Non-muslim Socioeconomic status  < UMR  ≥ UMR Wife support  Supportive  Unsupportive Access to Information  Health workers  Field officers (PLKB)  Cadre / community  Friends  Mass media

3 21 18 9 2

5.7 39.6 34 16.9 3.8

0 13 40

0 24.5 75.5

48 4 1 0

90.6 7.5 1.9 0

53 0

100 0

13 40

24.5 75.5

53 0

100 0

1 39 13 0 0

1.9 73.6 24.5 0 0

will affect an individual in the selection

the decisions of couples of childbearing age

methods of birth because of the increasing

in determining the choice of contraceptive

age of the increasing numbers of maturity,

use. Couples with large number of children’s

the maturity of thinking and act that makes it

living, generally prefer to use long-term

easier to get new information and gain

contraception in an attempt to limit the

experience.

In

associated

with

is

also

number of children, whereas on couples with

productivity.

The

small number of living children prefer to

results showed that the age may influence

choose short-term use of contraceptives to

the decision to undergo vasectomy. We

extend child birth spacing.10 Other studies

found higher proportion of vasectomy clients

have

were at the age ≥ 31 years, compared with

relationship between the number of children

men 3 people (75.5%). This is

mination of number of children held by each

consistent with research showing that the

couple depending on the family itself and the

number of children living owned will affect

child welfare conditions would influence the



Hal. 27-36

decision of couples of childbearing age in

various health products and innovations

determining participation in family planning.

such as contraceptives greatly influenced by

The

majority

of

respondents

had

the level of education. The higher the

elementary education level (90.6%). This is

education, the easier it is for someone to

not in accordance with the theory and the

accept an innovation particularly in the areas

results of previous research which stated

of health and more likely to wear a tool / way

that education is one of the factors that can

of modern family planning.6,15

influence the knowledge and attitudes about contraceptive

methods.

education

is

one

of

The problem of family planning is not just

factors

that

demographic and clinical problem but also

determine

a

person’s

knowledge

and

socio-cultural issues and religion, even

perception. Someone who is well educated

regulated in the Act (Act) No.10 of 1992

will have broader vision and more receptive

which states that the implementation of birth

to ideas and new ways of life. Highly

control, is done in a way that can be

educated individuals would respond more

accounted for in terms of health, ethical and

rational than those with less educated, more

religious affiliation of the related population.6,

creative and more open to reform efforts.

16

Someone who is well educated are generally

the support of society, including religious

more able to adjust to social changes. The

leaders. Despite initially being challenged,

higher the education the more increasing

eventually family planning programs are

proportion of those who know and use

supported by religious leaders with the

contraceptives to limit the number of their

understanding that family planning is not

children.13

one’s

against religion and is one of the efforts in

will

the setting of population to fight poverty,

contraceptive

ignorance, backwardness of the community

the

Education

knowledge influence

of

and the

The

will

one’s choice

level

In this study, all subjects are Moslem.

affect

knowledge of

Family planning program needs to have

methods. Knowledge concerning the rumors

in

in the community about vasectomy, it also

development.6,14

contributes to the low participation of men in doing vasectomy.14

order

to

support

the

nation

In Islam, there are groups that do not support family planning. They reason that

It is adviseable, educated people find it

The Qur’an does not allow the use of

easier to accept an inovasi. Education for

contraceptives because they are considered

acceptor

the

to be killing a baby, but there are also

choice of contraception and will indirectly

scholars who allow family planning program

affect the continuity of use. The results

(KB) to an agreement that allowed by

stated that education has an effect on

Shari’a (Islamic laws) which is an effort of

reproductive

of

arrangement or spacing births or temporary

contraceptives. Utilization of the public on

pregnancy prevention based on spousal

candidates

can

behavior

influence

and

use



Hal. 27-36

agreement because certain circumstances

can be either positive or negative depending

for the family benefit (beneficiaries). This is

on the knowledge, beliefs, attitudes and

in line with the purpose of family planning,

actions of peers.

which is to maintain the health of mothers

Research showed that the low number of

and children, support other population and

man in the doing family planning is largely

development programs to be part of human

due to familial factors, among others, the

rights.6

wife did not give any support.23 Other study

For income, 75.5% of subjects have salary

above

wage.

relationship between the attitude of the wife

Socioeconomic status of a family is of great

towards men participation in family planning.

influence on the selection of contraception,

18,22-24

because

to

the

minimum

results indicate that there is a significant

necessary

Most of respondents got information from

contraceptive services, participants must

field officers (73.6%). Providing information

provide funding. that

there

is

obtain 19

the

Research results suggest

that

a

associated

relationship

between

is

clear,

complete,

with

the

and

Family

correct Planning

economic status with the selection of

Program is extremely important. The family

contraception. This is because they think

planning goals, how the family planning

that in choosing of contraception should

program

indeed be seen from the capacity of their

consequences or side effects and so on,

ability to purchase contraceptives so that the

including the risk of complications and side

use of contraception is not considered

effects of contraceptive failure must be

6

will

be

adressed,

and

the

burdensome for its users. Another study

clearly understood by clients.

stated that there were strong influences

family planning information should not be

between economic status/income level on

hidden,

the use of vasectomy.15,18

choose the appropriate type of contraception

thus

potential

Therefore,

participants

can

All subjects received full support from

(informed choice).25 Attention to the quality

their wife (100%). The support has a positive

of service delivery, such as education,

effect, both physical, mental and social life.

counseling and skills in providing vasectomy

Social support is felt when a person is

contraceptive

experiencing confusion/stress. The support given by closest people will be very

service,

will

acceptance and use of vasectomy. Sources

of

information

increase 16

from

health

significant as a driving force for reducing

professionals is a very important factor to

stress, with support, will further decrease

increase male participation in vasectomy,

stress levels suffered.

19-20

Wife response

which delivery is supported by media

against vasectomy action to be performed

campaign through printable material and

by their husbands is a form of support of the

electronic devices.14 The new information on

wife towards her husband. Wife response

something that will provide foundation for the



emergence

of

new

cognitive

attitude.

Hal. 27-36

Factors medical treatment

Affective messages that are strong enough

As expressed by the informants, as follows:

will provide a basis for assessing affective

“Some say vasectomy is similar with castration, but for me they are different... castration tends to be a massive operation ....” (Informant 1st)

something that would formation of toward certain attitudes.27 There is a relationship between

subject’s

the

information

with

the

perception

of

Psychological factors

selection

of

As expressed by the informants, as follows:

contraceptive family planning. Someone who previously had received family planning

“Some says that vasectomy was creepy ... lots of terror of surgery .... hahahaha ... but it turns out to be just fine...” (Informant 4th)

information before, generally will not have Our

difficulty in selecting contraception.6

results

confirmed

that

clients

response’s to stigma was related to religious QUALITATIVE DATA ANALYSIS

factors, sexual, psychological and medical

Qualitative data analysis was performed

treatment. There are opinions from religious

to confirm the results from quantitative data

point of view that vasectomy is equated with

analysis. In-depth interviews was conducted

murder, in fact, there are the pros and cons

on 6 vasectomy clients and their wives also

of vasectomy by scholars, there is a permit

1

Village

to use vasectomy and some that do not

Purwakarta District. We classified the results

allow for vasectomy is haraam (forbidden)

into: responses to stigma of vasectomy and

similar to killing.

field

officer

in

Kiarapedes

the reasons of choosing vasectomy among their clients.

The stigma of vasectomy is associated with sexual factors, vasectomy is considered to make men become impotent. This is not

Responses to stigma

true

Stigma circulating in the community about vasectomy mostly related to religious, sexual,

medical

and

psychological

measures.

on

medical

perspectives

because

vasectomy procedure just cut the continuity of the vas deferens spermatozoa from testicular functioning channel, then there is a block of spermatozoa distribution through

Religious factors

the channel. The process of spermato-

As expressed by the informants, as follows: “Once there are scholars who say that vasectomy is haram (forbidden). It kills but in my opinion vasectomy does not kill, rather it protects... so ... " (Informant 6th)

genesis which takes between 70-90 days still can continue. Blockage of the vas deferens does not affect intersitiel tissue of the testis, so that the Leydig cells produce

Sexual factor

testosterone remained normal. Because

As expressed by the informants, as follows: “Some say... if you do vasectomy, it reduces your power...oh wait..no sweat... but in my experience such thing not happen” (Informant 1st)

testosterone production is not disrupted, the libido remain unchanged.28 Vasectomy also does not cause men to be impotent because



the nerves and blood vessels that play a role

Hal. 27-36

The Reasons of Choosing Vasectomy

in the process of erection are in the penis

Some factors which can explains why

shaft, while the action is only done around

vasectomy clients chose vasectomy are the

vasectomy scrotal / testis, away from nerves

condition from their spouses, economic

for erection that vasectomy will not at all

reason and the existence of role model.

interfere with the ability of the penis to

Spouse condition

erect.29 In addition, vasectomy does not

As expressed by informants, as follows:

affect the function of the accessory glands

“... Because long time ago my wive gave birth here, there’s such interference when my wife should be taken to the hospital ...because a lot of symptoms ... so it’s better if me as his husband is vasectomised” (Informant 2rd)

thus cement production still persists and vasectomised men can ejaculate.28 Vasectomy is different from castration. The act of castration is an act of throwing

Economic reason

away testicles for virility throw. Meanwhile,

As expressed by informants, as follows:

the act of vasectomy is the cutting/tying the

“Because I don’t want to have another baby, just 2 kids it’s enough for me, I don’t want to have another child, it is troublesome, for the cost and the sake of my children’s future” (Informant 5th)

left and right vas deferens, so that seminal fluid released during ejaculation no longer contain sperm. Vasectomy action takes a short operation about 10-15 minutes and requires no general anesthesia (anesthetic) just under local anesthesia only, so it is relatively safer.30-31 Anxiety is an unpleasant emotional state, which is characterized by subjective feelings such as tension, anxiety, worry, and also characterized by active central nervous system. Anxiety is generally vague, has no known cause, so the anxiety becomes an individual defense.32 The fear experienced by the people about vasectomy was caused by things that are uncertain. Our study revealed that most of clients claimed not to feel fear as rumored in the community. It is the attitude of the provider that can help clients to eliminate fear. The study results conducted by Santiso, et al

33

stated that 97

% of vasectomy clients felt satisfied with the action of vasectomy and did not regret it.

The existence of role model As expressed by informants, as follows: “My husband thinks .. there are already many people done vasectomy, Mr. Koko did it also... sometimes I’m thinking myself, Mr Koko choose to have vasectomy, but I don’t... so I finally decide to also have it” (Informant 5th)

In this study, we showed that reasons of choosing vasectomy among its clients are driven by the condition from their spouses, economic reason and the existence of role model. Economic factor indirectly influences the selection of family planning methods. When a family has large numbers of children, it may increase the family budget to meet the needs of clothing, food, housing and education as well. It agrees with the study results18,34 which states that there is a significant relationship between the level of income towards the use of vasectomy. Since vasectomy is a permanent birth control



Hal. 27-36

method then it is cost-effective. It requires

References

only one action that will be more economical

1.

Kemenkes

RI.

Profil

Kesehatan

and practical than other family planning

Indonesia. In: Kemenkes RI, editor.

methods. As a government programme,

Jakarta: Kemenkes RI; 2011.

vasectomy is provided free of charge to

2.

Baskara

UD.

intensify male participation in family planning

kependudukan

so

penghematan

they

can

become

clients

without

considering operating costs.

Manfaat dan

program

KB

terhadap

ekonomi

demi

kemakmuran masyarakat Jawa Barat.

Another reason from the subjects of

Diakses tanggal 18 Juni 2012 melalui.

choosing vasectomy is the existence of role

http://jabarbkkbngoid/rubrik/529/.

models. Role model is one element of

Barat: BKKBN Jawa Barat; 2011.

experience that can be seen by other people

3.

Jawa

BPS RI. Laju pertumbuhan penduduk.

that the use of family planning is harmless

Diakses tanggal 18 Juni 2012 melalui.

and

not

like

community

so

the it

rumors serves

existing

in

http://sp2010bpsgoid/indexphp. Jakarta:

examples

or

BPS; 2010.

evidence. Exemplary role or models have a

4.

Bappenas. Laporan pencapaian tujuan

major influence in the formation of a simple

pembangunan milenium di Indonesia.

personal

In:

example

that

requires

an

assessment of whether or not the behavior is dangerous before deciding to do so.

Bappenas,

editor.

Jakarta:

Bappenas; 2010. 5.

BPPKK RI. laporan riset kesehatan dasar. In: Kemenkes RI, editor. Jakarta:

Conclusion

Kemenkes RI; 2010.

Vasectomy

is

a

safe

method

of

6.

Kusumaningrum R. Faktor-faktor yang

contraception for men. Other factors that

mempengaruhi

influence the choice of vasectomy in addition

kontrasepsi

to age, number of children, education,

pasangan

religion, socio-economic, wife support and

UNDIP; 2009.

access to information is the existence of role

7.

pemilihan

yang usia

jenis

digunakan subur.

pada

Semarang:

Budisantoso SI. Partisipasi pria dalam

model. There is a need for efforts to

keluarga berencana di kecamatan Jetis

increase

kabupaten Bantul. Promosi kesehatan

the

promotion

of

male

contraceptive methods through education and

counseling.

Appropriate

health

Indonesia. Agustus 2009;4(2). 8.

Kurnia

RA,

A

DI.

Pengetahuaan

education about vasectomy should be given

kontrasepsi

vasektomi

to reduce vasectomy stigma within the

ditinjau dari umur,

community.

pekerjaan.

Falkutas

masyarakat

universitas

pada

suami

pendidikan dan kesehatan airlangga

Surabaya. 2008.



9.

Ekarini SMB. Analisis faktor-faktor yang berpengaruh terhadap partisipasi pria dalam

keluarga

berencana

di

Hal. 27-36

16. UU RI. UU RI No 20 tentang Sistem pendidikan nasional. Jakarta2003. 17. Saifuddin AB. Buku panduan praktis

Kecamatan Selo Kabupaten Boyolali.

pelayanan

Semarang:

YBPSP,

Universitas

Diponegoro;

2008.

kontrasepsi.

Jakarta:

JNPK-KR/POGI,

BKKBN,

DEPKES, JHPIEGO; 2003.

10. Singarimbun M. Kelangsungan hidup

18. Simanullang

R.

Pengaruh

faktor

anak,berbagai teori, pendekatan dan

predisposisi, pemungkin dan penguat

kebijaksanaan.

peserta

Yogyakarta:

UGM;

1996.

pria

terhadap

penggunaan vasektomi di kecamatan

11. Nafidah A. Survey cepat gambaran beberapa faktor suami yang berkaitan dengan

pemilihan

kecamatan

vasektomi

Pulosari

di

kabupaten

Pemalang bulan Juli - Oktober 2007. Semarang: UNDIP; 2007.

pria dengan keikutsertaan penggunaan vasektomi

Medan: USU; 2011. 19. Sarafino

EP.

Singapura:

Health

psychology.

John Willey and Sons;

1990;5-9.

health. Florida: Academic Press Inc.; 1985.

kecamatan

21. BKKBN. Keluarga berencana kesehatan

Kebumen

reproduksi, gender dan pembangunan

bulan April-Mei tahun 2002. Yogyakarta:

kependudukan, edisi Revisi. Jakarta:

UGM; 2002.

BKKBN; 2006.

Karanganyar

di

Labuhan Deli Kabupaten Deli Serdang.

20. Cohen S, Syme SL. Social support and

12. Fitri IR. Kaitan beberapa karakteristik

metode

kontrasepsi

kabupaten

13. Purwoko. Penerimaan vasektomi dan sterilisasi

tuba.

Semarang:

UNDIP;

2000.

22. Jayasuria R, Owen N. Predictors of men's

acceptance

of

modern

contraceptive practice in rural Vietnam.

14. BKKBN. mempengaruhi

Faktor-faktor

yang

rendahnya

partisipasi

pria dalam KB. Diakses tanggal 3 Juni 2007

melalui.

Health sagepub.

education

and

behavior.

2005.

10

Februari

2007;32(6):738. 23. Khotima FN, Palarto B, Julianti HP.

http://wwwbkkbngoid/gemapria/info-

Hubungan pengetahuan dan sikap istri

detailphp?infid=79: BKKBN; 2007.

dengan

15. Setyaningsih RW. kehidupan

rumah

Persepsi tentang tangga

dengan

pemilihan

kontrasepsi

vasektomi pada pasangan usia subur. Semarang: UNDIP; 2011.

keikutsertaan vasektomi di kelurahan

24. Simanjuntak RS. Tingkat adopsi inovasi

Tlogosari Kulon kecamatan Pedurungan

KB pria di kalangan prajurit wilayah

Kota Semarang tahun 2007. Semarang:

Medan tahun 2007. Medan: USU; 2007.

UNDIP; 2007.



25. Desra

ER.

Faktor-faktor

yang

Hal. 27-36

30. BKKBN.

Panduan

pelaksanaan

mempengaruhi partisipasi pria dalam

KIP/konseling kontrasepsi pria. Jakarta:

vasektomi di kelurahan Namo Gajah

BKKBN; 2008.

kecamatan Medan Tuntungan. Medan: USU; 2011.

tanpa pisau. Jakarta: BKKBN; 2008.

26. Wulansari, Hartanto. Ragam metode kontrasepsi. Jakarta: EGC; 2006. 27. Winarso

HP.

31. BKKBN. Panduan pelayanan vasektomi

Sosiologi

32. Jersild

AT.

The

psychology

of

adolesence. New York: The MacMillan

komunikasi

Company; 1965.

massa. Jakarta: Prestasi Pustaka; 2005.

33. Santiso R, Pineda MA, Marroquin M,

28. Taher A, Rasyid N, Asri, Mu'ammar.

Bertrand JT. Vasectomy in Guatemala:

Buku acuan vasektomi tanpa pisau.

A follow-up study of five hundred

Jakarta:

acceptors.

Perkumpulan

Kontrasepsi

Mantap Indonesia (PKMI); 2003.

Diambil

Desember

pada

tanggal

2012,

http://gemapria.bkkbn.go.id/consult-

&

Soc

Bio.

1981;28(3-4):253-64.

29. BKKBN. Gema Pria Pusat Informasi KB Pria.

Biodem

13 dari:

34. Kurnia RA. Pengetahuan kontrasepsi vasektomi pada suami ditinjau dari umur,

pendidikan

dan

pekerjaan.

Surabaya: Universitas Airlangga; 2008.

detail.php?conid=1377. 2012.
