Family Planning Counseling Workers' Discretion in Contraception Policy Implementation: Analysis of the Role of Socio Demographic Characteristics of Acceptors in Demak District

This study aims to analyze the discretion of family planning counselors in implementing contraceptive policies and the influence of acceptors' socio-demographic characteristics in Demak Regency. Using a mixed-methods approach with a sequential explanatory design, the study included 89 respondents for quantitative analysis and five key informants for in-depth interviews. The results showed a strong positive correlation between counselor discretion and acceptor socio-demographic characteristics (r = 0.646; p < 0.001), which explained 41.7% of the variance in discretionary practices. Counselors adapted communication strategies based on the age, education, geographic location, and culture of acceptors. Policy implementation faced obstacles in the counselor-community ratio (1:23) and the dominance of short-term contraceptive choices due to socio-cultural influences. Theoretical implications enrich the literature on street-level bureaucracy, while practical implications recommend strengthening counselors' capacity, increasing the ideal ratio, and implementing IEC strategies tailored to local culture. Limitations include a single geographic focus and a cross-sectional design. Future research is suggested to use longitudinal designs and multi-regional comparative studies to explore the dynamics of discretion in different socio-cultural contexts.