Family Planning In Indonesia Research Articles

National health insurance contribution to family planning program funding in Indonesia: A fund flow analysis.

Launched in 2014, Indonesia's national health insurance system (JKN) aimed to provide universal health coverage, including contraceptive services, to its population. We aim to evaluate the contribution of JKN to the overall spending for the family planning program in Indonesia. Data from the Indonesian Demographic Health Survey, Survey on Financial Flows for Family Planning, Indonesia Motion Tracker Matrix, World Population Prospect, and Indonesian ministries' budget accountability reports were entered into the CastCost Contraceptive Projection Tool to define budgetary allocation and spending for the family planning program at the national level in 2019. Indonesia's family planning program in 2019 was financed mostly by the national budget (64.0%) and out-of-pocket payments (34.6%). There were three main ministries responsible for family planning financing: the National Population and Family Planning Board (BKKBN) (35.8%), the Ministry of Finance (26.2%), and the Ministry of Health (2.0%). Overall, JKN contributed less than 0.4% of the funding for family planning services in Indonesia in 2019. The majority of family planning spending was by public facilities (57.3%) as opposed to private facilities (28.6%). JKN's contribution to funding Indonesia's family planning programs in 2019 was low and highlights a huge opportunity to expand these contributions. A coordinated effort should be conducted to identify possible opportunities to realign BKKBN and JKN roles in the family planning programs and lift barriers to accessing family planning services in public and private facilities. This includes a concerted effort to improve integration of private family planning providers into the JKN program.

Reducing Unmet Need for Family Planning in Indonesia: A Policy Analysis Report

The Indonesian government has already initiated many policies to reduce unmet need for Family Planning (FP), which is one of the three zeros commitment. It is crucial to understand whether a regulatory perspective is sufficient to solve the unmet need for family planning in Indonesia. This report explores the policy response to the unmet need of FP in Indonesia. This report draws from two sets of data. First, a document review contained 45 policies. The second set of data was qualitative interviews with the key informants collected as part of the policy analysis process of unmet need of FP. Forty five policies identified in the form of decrees, government regulations, and presidential regulations related to the unmet need for FP. Three themes emerged from the analysis: demand creation, supply side, and socio-demographic factors related to women. In the demand creation, we found varying commitments of the Provincial and District Governments in manage the FP programs. On the supply side, the government guaranteed the availability of contraceptives for all public and private health facilities, as long as they are registered in the BKKBN reporting system. However, there are still problems in distributing contraceptives, especially at the district level to the facilities. The last factors related to the unmet need for FP are the socio-demographic factors, such as fertility and socio-economic factors. In conclusion, at the national level, the policy covered has been adequate to address the demand creation and supply side, but not many about couple factors. The success of FP programs depends on the local government's strong commitment to including the unmet need of FP as their strategic plans

Regional Data Mining Implementation Of Contraceptive Equipment Users In The City Of Binjai By Type Using Clustering method

The government of the Binjai City BKKBN Office is one of the institutions responsible for controlling population growth and family planning in Indonesia which has a long-term impact that will occur if the family planning program is not implemented properly, there will be a population explosion and will cause various problems, including declining degree of health, social welfare, economic and cultural issues. Therefore, it is important to understand about contraception which will be useful in assisting the community in regulating birth rates and improving the quality of life, how contraceptives are used in Binjai City and how the levels of their use vary by region. This study aims to identify areas that use contraceptives in Binjai City based on the type of contraceptive used and to provide useful information for the government and health organizations in making policies and programs that benefit the community. Based on the results of the research conducted using a sample of 20 data, the results obtained from the data group are 12 data with the area group of contraceptive users in Binjai City based on their type with Age (X) being 18-25 years, and for the Kelurahan group (Y) is Binjai , and the type of contraception (Z ) injection for family planning.

Upaya Peningkatan Cakupan Akseptor KB Melalui Pelatihan dan Pendampingan Kader di Kampung KB Kota Padang

The incidence of unmet need family planning in Indonesia is increasing from year to year. In West Sumatra in 2017 it was 18.54%, still far from the target of reducing unmet need, total 9.91%. The high incidence of unmeet need is caused by a lack of knowledge about contraception, as well as the side effects caused by contraception. The KB village in the city of Padang has only touched 0.12% of couples of childbearing age, which is not optimal in controlling population growth. For this reason, the role of KB Village still needs to be increased through community participation and cross-sectoral integration. The aim of this econduct training and mentoring of family planning cadres in KB Village, Padang City. The method used is the participatory planning method, namely cadre training conducted 2 times pre and post test to ensure the ability of family planning cadres in implementing the program. The practical method is assisting cadres in providing education to PUS. The evaluation is carried out in two stages, namely the evaluation being carried out before the training and after the training. The final evaluation is carried out by holding meetings and evaluations with family planning cadres to find out the obstacles and follow-up plans. The result of this activity was an increase in cadre knowledge of 48.7% after training. There is an increase in the coverage of family planning acceptors in KB villages seen from the reporting of new family planning acceptors.

Reassessing the level and implications of male involvement in family planning in Indonesia

BackgroundAlthough there is global recognition of the importance of involving men in family planning and reproductive health matters, this issue has received insufficient attention in many countries. The present study sought to characterize married Indonesian males as to their level of involvement in family planning, identify the correlates thereof and assess the implications of male involvement for unmet need for family planning.MethodsA mixed methods research design was used. The main source of quantitative data was 2017 Indonesian Demographic Health Survey (IDHS) data from 8,380 married couples. The underlying “dimensions” of male involvement were identified via factor analysis. The correlates of male involvement were assessed via comparisons across the four dimensions of male involvement identified in the factor analysis. Outcomes were assessed by comparing women’s and couple’s unmet need for family planning for the four underlying dimensions of male involvement. Qualitative data were collected via focus group discussions with four groups of key informants.ResultsIndonesian male involvement as family planning clients remains limited, with only 8% of men using a contraceptive method at the time of the 2017 IDHS. However, factor analyses revealed three other independent “dimensions” of male involvement, two of which (along with male contraceptive use) were associated with significantly lower odds of female unmet need for family planning. Male involvement as clients and passive male approval of family planning, which in Indonesia empowers females take action to avoid unwanted pregnancies, were associated with 23% and 35% reductions in female unmet need, respectively. The analyses suggest that age, education, geographic residence, knowledge of contraceptive methods, and media exposure distinguish men with higher levels of involvement. Socially mandated gender roles concerning family planning and perceived limited programmatic attention to males highlight the quantitative findings.ConclusionsIndonesian males are involved in family planning in several ways, although women continue to bear most of the responsibility for realizing couple reproductive aspirations. Gender transformative programming that addresses broader gender issues and targets priority sub-groups of men as well as health service providers, community and religious leaders would seem to be the way forward.

Lack of sources of information on the low participation of men using family planning: A Scoping review

Family planning (henceforth; KB) is an attempt to control the number and spacing of children born. At present there are still many low participation of men in using family planning, where people always think that family planning only followed by women and men only as decision maker. The husband’s participation in family planning in Indonesia itself is still very low at around 1,3%. The factors that influence the use of contraception in men are vary, as for the factors that influence the use of contraceptive methods, namely the behavior of seeking contraceptive information. And men;s lack of access to information and services is a barrier to using contraceptive methods. Based on the background mentioned, it is important to conduct a study related to the lack information sources on male participation as family planning acceptors. The puspose of this scoping review is to find out the causes of the lack of information sources on the low interest of men to become family planning acceptors. The method used in the preparation of this scoping review used Arksey and O’Malley guideline the results obtained that the factors causing the low participation of men becoming a family planning acceptor is a factor. Sources of information (mass media, health promotion program) few men hear about contraception from health works and the lack of information about contraceptive services is a barrier for men to become family planning acceptors.

Curcumin, a potential oral herbal male contraceptive: a review article

Background: Worldwide, the population explosion and unintended pregnancies pose serious health issues. The family planning program is a vital element due to reducing population growth. Demographic data and family planning in Indonesia report that contraceptive use rates are 93.66% for women and 6.34% for men. Men's participation in family planning programs remains low, with options limited to vasectomy and condoms. Limited contraceptive options may explain the low participation rate. WHO recommends traditional medicine as a cost-effective substitute for manufactured medicines. The primary ingredient in turmeric, Curcumin, has antiviral, antibacterial, anti-inflammatory, and anticancer activities. In both animal and human clinical trials, it has demonstrated a lack of toxicity. Little research has been done on how it affects the male reproductive. Objective: This article reviews the literature regarding the effects of Curcumin in Curcuma Longa on male fertility. Conclusion: Curcumin in Curcuma Longa causes noticeable changes in the male reproductive system that reverse when treatment is discontinued. Therefore, Curcumin may potentially control male fertility as a male contraceptive.

Knowledge Affects the Participation of Women of Reproductive Age in the Use of Long-Term Contraceptive Methods

The trend of acceptors of family planning in Indonesia so far shows less use of long-term contraceptive methods compared to short-term contraceptive methods. This may be due to limited knowledge or information obtained by women of childbearing age couples, so the aim of this study was to determine the relationship between knowledge and participation of women of childbearing age in the use of long-term contraceptive methods. This type of correlation analytic research was a cross-sectional approach that was carried out in May-2012. June 2022. The research population was all female couples of childbearing age who used active contraception in the Petiken hamlet, Petiken village, Driyorejo Gresik District, totaling 345 women with a total sample of 182 women who met the inclusion criteria through simple random sampling. The data collection method was carried out directly with a research instrument in the form of a questionnaire. Data were analyzed using the Chi-Square statistical test. The results showed that knowledge influenced the participation of women of childbearing age in the use of long-term contraceptive methods (P = 0.000). Knowledge is a very important domain in the formation of one's actions so that a good level of knowledge will determine behavior in the use of long-term contraceptive methods.

HUBUNGAN PARITAS DAN DUKUNGAN SUAMI DENGAN PENGGUNAAN ALAT KONTRASEPSI INTRA UTERINE DEVIDE (IUD) DI KLINIK PRATAMA HANNA KASIH TAHUN 2020

Based on data from Indonesia's Health Profile in 2016, Indonesia has a population of 258,704,986 people. Indonesia still ranks fourth with the largest population in the world after America, India and China. The total population of Indonesia in 2019 is estimated at 268,074,565 people, consisting of 117,674,363 urban residents and 150,400,202 rural residents. One of the programs to reduce population growth in realizing a family planning program (KB). The results of the prevalence of family planning in Indonesia based on the 2015 Fertile Age Couples Monitoring Survey reached 65.4% with the IUD method, which is still very low (4.7%). This study aims to determine the relationship between parity and husband's support with the use of IUDs at the Hanna Kasih Primary Clinic in 2020. The population in this study were acceptors who currently use IUD KB and have used IUD KB but now choose other types of family planning. The number of samples in this study were taken by total sampling, amounting to 30 people. The results obtained in this study from 30 respondents the majority were Scundipara, namely 11 (36.7%) respondents. Based on husband's support, the majority received positive husband support, namely 22 (73.3%). Based on the bivariate analysis, there is a significant relationship between parity and husband's support with the use of IUD contraceptives at the Pratama Hana Kasih clinic in 2020, with p value for parity <0.05 (p = 0.015) and for husband support with p value <0.05. (p = 0.000). It is hoped that the head of the Pratama Clinique Hanna Kasih will continue to provide support in the selection of the IUD contraceptive and the husband will continue to provide positive support for the wife to continue to use the IUD contraceptive device.

FAKTOR – FAKTOR PENYEBAB RENDAHNYA AKSEPTOR ALAT KONTRASEPSI DALAM RAHIM DI BPM SUCI PAIMIN KECAMATAN BENDOSARI KABUPATEN SUKOHARJO

Introduction: The rationale for the birth of family planning in Indonesia is the population problem. The important aspects of population are the size of the population, the number of population growth, the number of deaths, and the number of population movements. Based on data from the Central Java Province BKKBN, the number of IUD KB participants in 2014 was 472,217.
 Objective: to describe the factors causing the low acceptors of intrauterine devices at BPM Suci Paimin, Bendosari District, Sukoharjo Regency.
 Method: This research method uses a single variable with a non-probability sampling technique, namely accidental sampling. Family planning acceptors at BPM Suci Paimin, Toriyo Village, Bendosari District, Sukoharjo Regency, were 57 respondents. The measuring instrument used is a questionnaire.
 Results: This study found that the factors that caused the low acceptors of intrauterine devices were elementary education at 42.1%, environmental factors did not support it at 86.0%, and husband's support 100% husband did not support or approve.
 Conclusion: The factors causing the low acceptors of intrauterine devices, the factor at BPM Suci Paimin, Bendosari District, Sukoharjo Regency, is the husband's most dominant support factor because 100% of husbands do not support or approve.

Contraceptive Use Dropout-adjusted Unmet Need for Family Planning

Background: In the last two decades, unmet need for family planning in Indonesia remains stagnant, and contraceptive discontinuation has increased. These two indicators describe the risk of unwanted pregnancy in a population. Therefore, this study aims to develop an accurate calculation of the unmet need for family planning in Indonesia. Method: The study uses 2017 IDHS data to compare unmet need at survey-time and five years preceding the survey, measured by contraceptive calendar data that measured history of contraceptive use within five years preceding the survey. Unmet need at five years preceding the survey is measured by calculating the proportion of months not using contraceptive to the duration of months exposed to pregnancy in a period of 69 months. The study population is married women in Indonesia, with a sample size of 35,681. Results: Unmet need with contraceptive calendar calculation is higher than unmet need at survey-time. A difference of 3% concerns an additional of nearly 1.6 million unwanted pregnancies. This study proves that the high number of contraceptive discontinuations is directly proportional to higher unmet need with contraceptive calendar calculation. Conclusion: In Indonesia, with a relatively high contraceptive discontinuation rate, the calculation of unmet need using the calendar method is more precise than at survey-time method. The study results suggest the use of unmet need calendar for countries with high contraceptive discontinuation rate and provision of primary health care that is responsive to a potential unwanted pregnancy.

Determinants Of Modern Contraceptives Use In Indonesia: A Spatial Analysis

Family planning in Indonesia is deemed as a strategic program to improve the quality of life for women. In reality, this program's development is influenced by social values and policy priorities in every region. Many studies have investigated the use of modern contraceptives in Indonesia, none of which presents the disparities in contraceptive use among regions. We conducted a descriptive and inferential analysis using secondary data from Government Performance and Accountability Survey (GPAS) 2019. This study determines the disparities in the use of modern contraceptives among married women between regions in Indonesia. Regional 1, as a pioneer of family planning program in Indonesia since 1969, has a higher modern contraceptive use prevalence (mCPR) than the national and other regions. Besides, the lowest mCPR is Regional 3 as the youngest of the program implementation. The three regions have diverse determinant factors of modern contraceptive use. This paper discusses the importance of considering the regional complexions to implement Indonesia's family planning program, especially modern contraceptives.

Women’s empowerment and unmet needs for family planning in Indonesia

The unmet needs target at 9.9 percent from 2015-2019 The National Medium-Term Development Plan has not been achieved. The 2017 Indonesia Demographic and Health Survey (IDHS) show that unmet needs were 10.6 percent. Unmet needs are factors causing unwanted pregnancy, which can cause maternal morbidity and mortality; to improve maternal health, that is necessary to address women’s empowerment, which is the fifth objective of Sustainable Development Goals (SDGs). This study aims to study the relationship between women’s empowerment on the unmet needs in Indonesia. This study uses data from the 2017 IDHS. The analysis unit is fecund women who were married and required family planning involving observations of 26,249 individuals. The analytical methods used are binary and multinomial logit regression. The results showed that the components of women’s empowerment had a statistically significant effect on all unmet needs categories, namely women’s work participation, level of knowledge, participation in household decision making, and asset ownership. Women’s work participation, level of knowledge, and asset ownership negatively affect unmet needs. Participation in household decision making has a positive effect on unmet needs. Meanwhile, attitude toward wife-beating has no significant effect on all unmet needs categories.

Health Promotion Strategy for Improving Men’s Participation in Family Planning Program in the Underdeveloped Areas, Borders and Islands and Poor Urban Areas

The participation of men in family planning in Indonesia is still very low, where the men who use the MedicalMale Operations (MOP) method are only 0.2% while the condom use is 3.1% (IDHS 2017), Likewise inEast Java only 3.7% of the total new KB participants in 2019. The conditions most in need of attention arein underdeveloped areas, borders, islands and poor areas, which are in dire need of appropriate strategicbreakthroughs. The conditions most in need of attention are underdeveloped areas, borders, islands andpoor areas, which are in need of appropriate strategic breakthroughs. Strengthen the advocacy efforts fornew regional leaders so that the family planning program can continue to run in the regencies/cities withouthaving to start from zero again, provide training to male family planning motivators so that the informationprovided to prospective acceptors is more detailed and accurate and follows up the results of training ofmedical personnel and midwives.

Analysis of Factors Affecting the Unmet Need Incidence in Couples of Childbearing Age in the West Bulotadaa Village Gorontalo City in 2019

BACKGROUND: Population that continues to increase is a big problem for countries in the world, especially developing countries. One of the problems in the management of family planning programs is the high level of unmet need for family planning in Indonesia. Unmet need is the number of couples of childbearing age who want to postpone pregnancy or do not want additional children but do not use birth control methods.
 AIM: The aim of the study was to determine the determinants of the occurrence of unmet need in fertile age couples in the West Bulotadaa Village, Gorontalo City.
 METHODS: The study design was cross-sectional with a sample of 146 fertile age couples selected by systematic random sampling. Data collection was made, using questionnaires containing questions from the research variables. Data were analyzed by multiple logistic regression analysis through the SPSS for windows program.
 RESULTS: The visit of KB officers affected the unmet need with p = 0.032 (p < 0.05) with OR = 2.893, and there were some variables that were not significant such as the age variable p = 0.766 (p > 0.05), family income p = 0.189 (p > 0.05), distance of family planning services p = 0.057 (p > 0.05), and cost of contraception p = 0.632 (p > 0.05).
 CONCLUSION: It was concluded that the visit of family planning officers affected the unmet need and age, family income, distance to the place of family planning services and the cost of contraceptives did not affect the incidence of unmet need in West Bulotadaa, Gorontalo City.

Determinant of unmeet need family planning in Indonesia (PMA 2015)

This study was made to describe the effectiveness of family planning needs in married women in Indonesia and the factors that influence them. This research is descriptive analytic study using the Cross-Sectional Study design. This research uses Performance Monitoring and Accountability (PMA2015/Indonesia-R1) data. The research subjects were 7672 women (married). Data were analyzed using SPSS. The results showed that married women who unmet need is 16% in Indonesia. On the sociodemographic characteristics of age, education and number of children significantly associated with the unmet need (p=0.000). This study recommended expected that policy makers of family planning programs and related agencies need to improve socialization of program implementation and ideal number of children planning and also require a comprehensive and systematic way to improve efforts and coverage of family planning acceptors, one of which is by making a renewal in the use of media.

Education Relations, Number of Children and Acceptance of KB Information with Pregnancy Due to Unmet Need KB in Pregnant Mother in Binjai Health Center City In 2019

Pregnancy control and regulation is one of the ways to suppress the population in Indonesia through the family planning (KB) program. However, family planning programs in Indonesia still have problems, one of which is the high number of unmet need for family planning in Indonesia. 5 sub-districts in the City of Binjai showed that the District of Binjai Kota which had the highest number of unmet need for family planning was 18.27%. The purpose of this study was to analyze the Relationship of Education, Number of Children and Acceptance of Family Planning Information with Pregnancy Due to Unmet Need for KB in Pregnant Women in Binjai City Health Center in 2019. The method of this study used a cross sectional sample of 113 pregnant women in December 2018 - August 2019 at the Binjai City Health Center. Data were collected by interview using a questionnaire. Based on the results of the study note that out of 113 pregnant women there were 57 people (50.4%) who became pregnant as a result of Unmet Need KB. Variables related to Pregnancy Due to Unmet Need for KB are the number of children (p = 0.024) and the receipt of KB information (p = 0.001). The results of multiple logistic regression showed that respondents who had 1-2 children and did not receive family planning information had a probability of suffering from pregnancy due to unmet need for birth control by 57.8%. The suggestion for this research is that health workers pay more attention to those who have 1-2 children who are motivated to participate in the family planning program and ask pregnant women to ask health workers before using family planning tools as clearly as possible so that they are expected to be able to reduce the reasons for unmet need for family planning.

Determinants of unmet needs for family planning in Indonesia: Secondary data analysis of the 2017 IDHS

Background: Globally, the unmet need for family planning remains high. The proportion of unmet needs for family planning (FP) in Indonesia was found to have declined but was still higher than the set target. In the last 5 years there have been significant development in Indonesia including infrastructure, the National Health Insurance Program and the increasing allocation of funds to all villages throughout Indonesia. This study aims to determine the factors associated with unmet needs for family planning in Indonesia.Methods: This study uses secondary data from the 2017 Indonesia Demographic and Health Survey (IDHS) that was carried out in 34 provinces in Indonesia. The number of the analyzed samples was 26,479 of the total 2017 IDHS sample of 35,681 women aged between 15-49 years. The dependent variable is the unmet need for FP, while the independent variables consist of four core variables namely individual, household, community and programmatic variables. Data analysis was performed with a binary logistic regression to obtain the adjusted odd ratio of each factor.Results: The proportion of unmet needs in this analysis was 14.3% (95%CI: 13.9-14.7%). Factors related to unmet needs are maternal age 25-34 years (AOR=1.17; 95%CI=1.01-1.36), 35-44 years (AOR=1.46; 95%CI=1.23-1.73), ≥45 years (AOR=2.20; 95%CI=1.81-2.68), age of last child ≥10 years (AOR=1.28; 95%CI=1.14-1.42), number of living children <2 (AOR=1.68; 95%CI=1.51-1.87), ideal number of children >2 (AOR=1.34; 95%CI=1.24-1.45), have >1 son (AOR=1.12; 95% CI=1.00-1.25), husband not working (AOR=1.90; 95%CI=1.45-2.49), lack of knowledge about family planning methods (AOR=1.36; 95%CI=1.19-1.55), higher wealth index (AOR=1.13; 95% CI=1.03-1.24), not discussing family planning with partners (AOR=1.11; 95%CI=1.02-1.20), low women's autonomy (AOR=1.13; 95%CI=1.04-1.24), living in urban area (AOR=1.26; 95%CI=1.17-1.37) and regions with TFR >2.4 (AOR=1.62; 95%CI=1.46-1.81).Conclusion: The proportion of unmet needs in Indonesia is still high and the dominant associated factor is the age of the mother ≥45 years. In order to decrease the FP unmet needs, the intervention programs should be targeted to groups of women who are at risk of experiencing such unmet needs.

Faktor-Faktor yang Berhubungan dengan Keikutsertaan Pasangan Usia Subur (PUS) dengan Penggunaan Alat Kontrasepsi di Desa Alamendah Kecamatan Rancabali Kabupaten Bandung

Indonesia is a country has a very high number of occupations. One of the government’s effort to control the population is by using a family planning program. However, the participation rate of Fertile Age Pairs in the use of family planning in Indonesia is not maximal This study aims to determine the factors that influence the participation of Fertile Age Couples in the use of contraceptives. The design in this study was analytic with a cross sectional approach conducted in Rancabali sub-district, Alamendah, Bandung, using primary data by filling out questionnaires. The population in this study were all of the fertile age couples with a total of 228 respondents. The statistical test used is Chi-Square. From the analysis of data from 288 respondents, 210 used Participating in using KB while 78 did not participate. The results of the study concluded that there was a relationship between the variables of knowledge, education and the role of the PLKB and family planning acceptors, while the variables of work, age and husband's support were not related.

KNOWLEDGE, ATTITUDE, AND BEHAVIOR ABOUT ABORTION AMONG ADULT WOMEN AT PEUNAYONG DISTRICT, BANDA ACEH, INDONESIA

Objective: Every year approximately 13% (78,000) of maternal death caused by unsafe abortion. Indonesia Family Planning Association predicts 2.5 million abortions per year and 1.5 million of them committed by teenagers. Adolescent reproductive health problems are more alarming year by year. Sexual behavior tends to be permissive and bold with limited knowledge of reproductive health has increased the risk of abortion. This study is to assess the knowledge, attitudes, and behavior regarding abortion in young adults.
 Methods: This is a descriptive cross-sectional study. The subjects were young women aged 18–24 years old who were fulfilled by inclusion and exclusion criteria. The knowledge, attitudes, and behavior were assessed using questionnaire. The results were analyzed using statistical program.
 Results: The total subjects recruited in this study were 55 subjects. Twenty-eight (50.9%) of subjects has a good knowledge and 27 (49.1%) of subjects had a moderate knowledge. Twenty-nine (52.7%) subjects had moderate attitudes and 36.4% of subjects had good attitude. Thirty (54.5%) of subjects had a good behavior regarding abortion.
 Conclusion: Most of the subjects had good level of knowledge and moderate attitude toward abortion.