177Unzila, Agustina, The Effectiveness of Family Support on ... 177 The Effectiveness of Family Support on Pregnancy related to Anxiety at Kepanjenkidul Primary Care in Blitar Regina Firda Unzila1, Ika Agustina2 1,2Department of Midwifery, STIKes Patria Husada Blitar, Indonesia Article Information History Article: Received, 11/12/2019 Accepted, 23/04/2020 Published, 05/08/2020 Keywords: Pregnancy Related Anxiety, family support Abstract Pregnancy Related Anxiety (PRA) is an anxiety felt by pregnant woman related to pregnancy. PRA is different from the general anxiety felt during pregnancy, and contributing to a greater risk of preterm birth. According to the survey at Kepanjenkidul Primary Care in Blitar City, there were 7 cases of preterm birth during 2017-2018. Family support could reduce the risk of PRA. Family support could make pregnant women calmer and relaxed during preg- nancy. The purpose of this study was to determine the effectiveness of family support on the level of PRA at Kepanjenkidul Primary Care in Blitar. The study design was cross sectional, involved 50 respondents, chosen by accidental sampling. The data collected by PRAQ-R2 questionnaire used to measure PRA levels while social support questionnaire used to measure the support of family. The data was analyzed with Kendall’s Tau. The results of the study showed that there was an effect of family support with anxiety levels by p value of 0.0001 < 0.05. The study concluded there was an effect of family support on the level of pregnancy related to anxiety. The family supports could decrease the risk of pregnancy related to anxiety. © 2020 Jurnal Ners dan Kebidanan Correspondence Address: STIKes Patria Husada Blitar – East Java, Indonesia P-ISSN : 2355-052X Email: ikapatria45@gmail.com E-ISSN : 2548-3811 DOI: 10.26699/jnk.v7i2.ART.p177–181 This is an Open Access article under the CC BY-SA license (http://creativecommons.org/licenses/by-sa/4.0/) JURNAL NERS DAN KEBIDANAN (JOURNAL OF NERS AND MIDWIFERY) http://jnk.phb.ac.id/index.php/jnk JNK https://crossmark.crossref.org/dialog/?doi=10.26699/jnk.v7i2.ART.p177-181&domain=pdf&date_stamp=05-08-2020 https://doi.org/10.26699/jnk.v7i2.ART.p177-181 178 Jurnal Ners dan Kebidanan, Volume 7, Nomor 2, Agustus 2020, hlm. 177–181 INTRODUCTION Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR) are one indicator of health development in the 2015-2019 RPJMN and SDGs. Based on 2015 AKI Inter-Census Population Survey (SuPAS) data of 305 per 100,000 live births; IMR is 22.23 per 1000 live births (Directorate of Family Health, 2016) The psychological state of anxiety and fear greatly influences physical function of the body. This case will greatly affect the function of organs, for example the organs involved in labor become less strong, encouragement from the body is also not strong so that it inhibits the process of labor and childbirth (Nisman, 2011). According to the results of a survey at UPTD Puskesmas Kepanjenkidul in Blitar City, the number of deliveries in 2017 at the Kepanjenkidul sub-district level was 533. In 2018 there were 561 deliveries. There have been 1 case of maternal deaths in the past two years with the cause of pregnancy bleeding due to placental abruption. The number of deliveries at the Kepanjenkidul Community Health Center in 2018 was 239 with a total of 69 referral cases. The number of referrals due to the first stage of labor extended by 13 cases with a percentage of 18.84%; labor with stage 2 lengthening by 2 cases with a percentage of 2.89%; fetal distress in 5 cases with a percentage of 7.24%; LBW cases and premature as many as 7 cases with a percentage of 10.14%. Regula tion of the Minister of Women Empowerment of the Republic of Indonesia Number 1, 2008 concerning Guidelines for Implementing the Impr ovement of Women Qua lity Life. T his regulation supports the role of the husband in the condition of preparedness to provide assistance and support his wife during pregnancy, childbirth and parturition (Kementerian Pemberdayaan Pere- mpuan dan Perlindungan Anak RI, 2008) United Nations Population Fund (UNPF) supports that the great role the husband’s participation in maternal health will reduce the amount of morbidity and maternal death caused by death and childbirth METHOD The design of this study was observational, with a cross sectional study approach. The population in this study were all pregnant women who did Antenatal Care at UPTD Puskesmas Kepanjen kidul, Blitar for 5 days totally 50 samples. The research instrument in this study used the Pregnancy Rela ted to Anxiety Questionnaire-Revised 2 (PRAQ-R2) research instrument and the family support questionnaire (social support). No age f % 1 < 20 year 0 0 2 20-34 year 45 90 3 > 34 year 5 10 Total 50 100 Table 1 Distribution of respondents based on age at the health center of Kepanjenkidul, Blitar No Gestational Age f % 1 Trimester I 12 24 2 Trimester II 20 40 3 Trimester III 18 36 Total 50 100 Table 2 Distribution of respondents based on gesta- tional age at the health center of Kepanjenkidul, Blitar No Education f % 1 SD 5 10 2 SMP 11 22 3 SMA 25 50 4 PT (Perguruan Tinggi) 9 18 Total 50 100 Table 3 Distribution of respondents based on education at the health center of in the Kepanjenkidul, Blitar No The Job f % 1 IRT (Ibu Rumah Tangga) 39 78 2 Petani 0 0 3 Buruh 1 2 4 Wiraswasta 9 18 5 PNS (Pegawai Negeri Sipil) 1 2 Total 50 100 Table 4 Distribution of respondents based on the job at the health center of Kepanjen Kidul, Blitar 179Unzila, Agustina, The Effectiveness of Family Support on ... No Pregnancy f % 1 Pregnat to 1 12 24 2 Pregnat to 2 24 48 3 Pregnat to 3 10 20 4 Pregnat to 3 4 8 Total 50 100 Table 5 Distribution of respondents based on the num- ber of pregnancies at the health center of Kepanjenkidul, Blitar Table 6 Distribution of respondents based on the num- ber of children at the health center of Kepanjenkidul, Blitar No Number Of Children f % 1 0 13 26 2 1-3 35 70 3 >3 2 4 Total 50 100 RESULT Table 7 Distribution of respondents based on family support at the health center of Kepanjenkidul, Blitar No Family Support f % 1 High support 33 66 2 Medium support 14 28 3 Low support 3 6 Total 50 100 Table 8 Distribution of respondents based on anxiety level at the health center No Anxiety Levels f % 1 No anxiety 32 64 2 Mild anxiety 4 8 3 Moderate anxiety 12 24 4 Severe anxiety 2 4 Total 50 100 Family Support Anxiety Levels No anxiety Mild anxiety Moderate anxiety Severe anxiety Total f % f % f % f % f Low 0 0 0 0 1 8 2 100 3 Medium 1 3 2 50 11 92 0 0 14 High 31 97 2 50 0 0 0 0 33 Total 32 100 4 100 12 100 2 100 50 Sig. (2-tailed) 0.000 Correlation coefficient    -0.879 Table 9 The influence of family support on anxiety levels of pregnant women at the Kepanjenkidul Health in Blitar City in July DISCUSSION Family support for pregnant women Based on research at Kepanjenkidul Public Health Center in Blitar on 10-16 th of July 2019, it was found that table 4.7 was mostly of high respondent family support. Based on table 4.1 90% of respondents have the age of 20-34 years oid. According to Purnawan (2008) in Rahayu (2008) support can be determined by the age factor in this ca se is growth a nd development, thus every vulnerable age (baby-elderly) has an understanding and response to different health changes. Beside of the age factor, education is also be able to influence one’s perception on family support. The last education taken by someone shows the knowledge possessed by someone, more higher knowledge, the better it will be in accepting and understanding other people’s treatment on him. Based on table 4.3, 25 of the 50 respondents (50%) had a high school education. According to Rinto (2012) information support from the family is also very useful in helping patients to overcome the anxiety experienced. 180 Jurnal Ners dan Kebidanan, Volume 7, Nomor 2, Agustus 2020, hlm. 177–181 2009). Whereas if it is related to work factors, it can also pose a risk of experiencing anxiety / worry of not being able to maintain the pregnancy due to fatigue due to work and the responsibilities of the work itself. Based on table 4.4 it can be seen that the work of the majority of IRT respondents (Housewives) is 39 out of 50 respondents (78%). Outside of education factor and employment which becomes the causes of anxiety related to pr egna ncy ca n a lso be influenced by the respondent’s parity. Based on table 4.5, the highest per centa ge of pr egna nt women pa r ity in Kepanjenkidul Health Center in Blitar is the second category of pregnancy 24 but of 50 respondents (48%). Parity can affect anxiety, because it is related to psychological aspects. Effect of family support on the level of anxiety of pregnant women Based on table 4.9, that respondents who received high family support did not have anxiety related to pregnancy as many as 31 out of 33 respondents (94%). Respondents who get family suppor t ar e exper iencing a nxiety rela ted to pregnancy with a moderate category as many as 11 out of 14 respondents (92%), respondents who get low family support experience anxiety related to pregnancy with heavy categories as many as 2 out of 3 respondents (67%) and experience anxiety related to pregnancy with a medium category 1 out of 3 respondents (33%). The results of this study are also in accordance with Handayani’s study (2012) that there is a significant relationship between husband’s support and anxiety levels before delivery in the Lubuk Buaya Public Health Center in Padang with a value of p <0.05. Family and husband support greatly affect the level of anxiety in third trimester pregnant women before the birth process. Because by providing ongoing support for third trimester pregnant women before delivery, can provide a sense of security and comfort. So as to reduce the level of anxiety in third trimester pregnant women (Jannah, 2015). The existence of a nega tive, strong a nd significant influence of family support on the anxiety level related to pregnancy in this study is acceptable. This can be seen from the results of the correlation coefficient r = -0.879 and a significant value (p <0.05) which means that family support significantly influences the level of anxiety of pregnant women. Negative results on the correlation coefficient mean Anxiety level in pregnant women T he r esults of conducted r esea r ch a t Kepanjenkidul Public Health Center in Blitar on 10- 16 th of July 2019 depicted in table 4.8 that 32 out of 50 respondents (64%) did not experience anxiety r ela ted to pr egna ncy, 4 r espondents (8%) experienced anxiety related to pregnancy in the mild categor y, 12 respondents (24%) experienced pregnancy-related anxiety and 3 respondents (4%) experienced pregnancy-related anxiety. Manuaba (2013) states the anxiety of pregnant women is influenced by two factors, namely internal factors and external factors. Internal factors include: age, education, knowledge, attitude, income, job while external factors include: bustle, health services and mental support. Age is able to influence the level of anxiety in a woman’s pregnancy, because people who are getting older (> 35 years old), the organ functions will decrease and cause a high-risk pregnancy so that the anxiety level will be higher too when knowing that the pregnancy experienced is a risky pregnancy , and vice versa if the age is still immature (<20 years) then the function of the genital organs is still not r ea dy to a ccept pr egnancy, a nd psychologically. As explained by Susanti (2008), that the age of the mother <20 years and> 35 years will have an impact on feelings of fear and anxiety before the birth process. If the mother is pregnant in this age, her pregnancy is included in the high risk pregnancy category and an older woman will have a high potential for giving birth to a disabled ba by. Based on table 4. 1 tha t 45 out of 50 respondents (90%) are aged 20-34 years. This case shows that most respondents have an ideal age in pregnancy, so the risk of respondents experiencing anxiety related to pregnancy is relatively low. In addition to the majority of respondents who are in the ideal age for pregnancy, low levels of anxiety related to pregnancy may also be related to gestational age, most of the respondents entering the second trimester, as illustrated in table 4.2 that there are 20 out of 50 respondents (40%) reached the age of the second trimester of pregnancy. Trimester II is the quietest period of pregnancy because the mother is getting used to her pregnancy, besides the levels of hCG (Chorionic gonadotrophin hormone) that causes nausea felt in the first trimester has begun to decrease and have not felt discomfort such as back pain and pain before childbirth as felt in the third trimester (Stoppard, 181Unzila, Agustina, The Effectiveness of Family Support on ... that pregnant women who get high family support have a lower risk of experiencing anxiety related to pregnancy. CONCLUSIONS The results of research and data analysis are the fa mily suppor t of r espondents a t the Kepanjenkidul Health in Blitar based on the results of the study, 66% received high support, the anxiety level of respondents at Kepanjenkidul Health in Blitar based on the results of the study was 64%, no one anxiety. Results of the study showed that there was an influence of family support with anxiety levels with p value of 0.0001 <  0.05. That means there is a negative influence where pregnant women who get high family support have a lower risk of experiencing anxiety related to pregnancy, and there is a significant significant effect shown in Kendall’s tau test. SUGGESTIONS Suggestions in this study are: for the research site it is expected that the results of this study can be used as information and can be used as a means of developing MCH health services to provide family support to reduce anxiety levels during pregnancy through non-governmental organizations such as classes of pregna nt women, for respondents expected families to participate in supporting ma ter nal pr egna ncy both in a n a ssessment, instrumental, informational and emotional manner, so that it can help reduce anxiety in the mother in dealing with her pregnancy. For the next researcher can by adding a new variable, namely the influence of family support and health workers on the level of anxiety of pregnant women in the trimester 3. REFERENCES Direktorat Kesehatan Keluarga. (2016). Laporan Tahunan Direktorat Kesehatan Keluarga Tahun 2016. Jakarta: Laporan Tahunan Direktorat Kesehatan Keluarga Tahun 2016. Handayani, R. (2012). Faktor-Faktor Yang Berhubungan Dengan Tingkat Kecemasan Menjelang Persalinan Pada Ibu Primigravida Trimester III di Wilayah Kerja Puskesmas Lubuk Buaya Padang Tahun 2012. Ners Jurna Keperawatan 11(1), 62-71. Jannah, N. (2015). ASKEB II Persalinan Berbasis Kompetensi. Jakarta: EGC. Manuaba. (2013). Ilmu Kebidanan Penyakit Kandungan dan Keluarga Berencana edisi 3. Jakarta: Buku Kedokteran EGC. Nisman, W. A. (2011). Ternyata Melahirkan itu Mudah dan Menyenangkan. Yogyakarta: Penerbit And. Purnawan, I. (2008). Dukungan Suami dan Keluarga. Jakarta: Salemba Medika. Rahayu, S. (2008). Keperawatan Keluarga. Yogyakarta: Graha Ilmu. Stoppard, M. (2009). Buku Panduan Lengkap Keha- milan & Persalinan Modern. Yogyakarta: Media Abadi. Susanti. (2008). Psikologi Kehamilan. Jakarta: Penerbit Buku Kedokteran. EGC.