The Relationship between Adolescent Girls' Behavior on Reproductive Health and the Motivation to Do Premarital Health Examinations

: Reproductive health is the starting point for developing maternal and child health, which can be prepared early, even before a woman becomes pregnant and a mother. Preconceptional health is part of the overall health between women and men during their reproductive years. This study analyzes the relationship between adolescent girls' behavior on reproductive health and motivation to conduct premarital health examinations in Gading Kulon Village, Probolinggo. This quantitative research design with a correlational design using a study approach across sectional with 34 respondents using an accidental sampling technique. Data collection included coding, editing, and tabulating, then analyzed manually and by computer with Spearman Rank. Based on data from 34 respondents, most of the behavior of young women regarding reproductive health was lacking; 22 respondents (64.7%) included motivation to carry out premarital examinations, namely two respondents (5.9%) were good, 14 respondents (41.2%) sufficient, while 18 respondents were lacking (52.9%) was found p=0.002, there is a relationship between female adolescent behavior regarding reproductive health with motivation to carry out premarital health checks in Gading Kulon Village, Probolinggo. Therefore, the existence of youth groups must be addressed.


INTRODUCTION
Adolescence is a period of transition or transition from childhood to adulthood which includes mental, emotional, social, and physical maturity (Ananda & Apsari, 2020;Allaili et al., 2021). The characteristic that can be seen is that many changes occur, both physical and psychological changes (Diananda, 2018). Adolescence is the most beautiful adjustment period, and almost all adults go through this period with unforgettable memories. Still, it is often accompanied by upheavals and problems, both medical and psychological problems. Adolescents are certainly in a vulnerable phase and contracting diseases that can affect their quality of life, resulting in increased stress Cahyani et al., 2022). Adolescence is a time of rapid changes in the process of physical, cognitive, psychosocial/behavioral, and hormonal growth. The flow of information that is increasingly sweeping the world has inevitably changed the views and sexual behavior of Indonesian adolescents, resulting in deviations that lead to the fading of norms in society that are related to their reproductive health (Soetjiningsih, 2014). Adolescents experience many changes, emotional instability, and stressful problems (Pratiwi et al., 2021). Adolescents who feel misunderstood often engage in aggressive behavior that can lead to risky behavior (Kurniyawan et al., 2023).
Based on the Indonesian Demographic and Health Survey (IDHS, 2018), 28.46% of Indonesia's population consists of teenagers, 20% of Indonesian teenagers have had premarital sex. There are around 2.3 million abortions performed each year, and 15% of abortions are performed by adolescents aged 16-20 years. The number of cases of HIV/AIDS was 4,159 sufferers, 30% of which occurred in adolescents aged 15-20 years. Adolescents' knowledge level about adolescent reproductive health (KRR) is still low. Only 55% of adolescents know the process of pregnancy properly, 42% of adolescents know about HIV/AIDS, 24% of adolescents know how to prevent transmission of HIV/AIDS, and only 27% of adolescents know about PMS. Management of self-management in adolescents must be maximally prepared (Kurniawan et al., 2022). Because HIV/AIDS-related events can occur in urban and rural areas (Aliyah et al., 2019).
Behavior is the activity of an individual starting from a stimulus or stimulus that meets the individual and does not arise without a cause. Human behavior is a reflection such as knowledge, perception, interests, desires, and attitudes. Things that influence a person's behavior lie within the individual/internal factors, from outside himself/external factors, driven by the activity of the organism's system and response to stimuli (Goddess, 2020). Reproductive health behavior, which includes knowledge, attitudes, and actions, greatly influences the emergence of adolescent reproductive health problems. Reproductive health is not merely free from disease or disability related to the reproductive system, functions, and processes. Reproductive health is a state of complete physical, mental, and social well-being. Good knowledge is also needed for good reproductive health behavior (Bawental et al., 2019). The correlation between improved health outcomes is that it can improve the quality of life, even though you have a chronic illness that you are suffering from .
Motivation is the process of influencing or pushing from the outside towards a person or workgroup so that they want to carry out something that has been determined. Motivation is the encouragement or stimulus that makes a person do the work he wants voluntarily without feeling forced so that the work can go well or produce something satisfying. Wahyudi & Tupti, 2019). The motivation to carry out pre-marital or pre-pregnancy health checks is becoming increasingly important, bearing in mind that the rate of information increasingly influencing the world has become the cause of society's revolution in assessing premarital sex. We cannot pretend not to see or hear about reproductive health problems, which are increasing so that they become a link in the chain of disease transmission. In Indonesia, awareness of doing premarital checkups still needs to be improved (Wati et al., 2021).
Based on a preliminary study on March 27, 2022, using the interview method of 10 teenagers who wanted to marry (premarital), it was found that of all the youths interviewed who admitted to having dated, six students (60%) stated that they had been dating since they were in junior high school. None of the students had who understand thoroughly about reproductive health. Lack of understanding about reproductive health behavior in adolescents is very detrimental to adolescents themselves, including their families, because, during this period, adolescents experience important developments, namely cognitive, emotional, social, and sexual. This development starts from after 12 years to 20 years. This lack of understanding is caused by various factors, including customs, culture, religion, and a lack of understanding of the correct source. This lack of understanding harms youth groups and their families (Soetjiningsih, 2014). So, this study aimed to analyze the relationship between adolescent girls' behavior on reproductive health and motivation to conduct premarital health examinations in Gading Kulon Village, Probolinggo.

METHOD
This research design is quantitative with a correlational design using a cross-sectional study approach. In a cross-sectional study, the subject is observed only once through measurement or observation simultaneously to see the independent variables (Independent) and related (Dependent). The independent variable in this study was the perception of young women. The dependent variable was premarital health checks. The population in this study was 34 young women in Gading Kulon Village in May-June 2022-the sampling technique used in this study, namely total sampling. The sample taken is the relationship between the behavior of young women regarding reproductive health and the motivation to carry out premarital health checks in the village of Gading Kulon, Probolinggo, in March and August 2022-a total of 34 people. The primary data in this study were in the form of answers to questionnaires about reproductive health with the motivation to carry out premarital health checks. The data collection method that the author uses is a questionnaire. The data processing technique includes editing, scoring, coding, and tabulating. The data analysis technique used was Univariate Analysis with Frequency Distribution and Bivariate Analysis with Spearman.   Table 2 shows that most of the behavior of young women regarding reproductive health needs to be improved in the number of 22 respondents (64.7%) and good in the number of 3 respondents (8.8%). Most of the motivation to carry out premarital health checks needs to be improved in 18 respondents (52.9%), and the good ones are in the number of 2 respondents (5.9%). From the table above, of the 34 respondents, most of the behavior of young women regarding reproductive health was lacking, 22 respondents (64.7%), enough nine respondents (26.5%), and good three respondents (8.8%), and motivation carried out premarital examinations, namely 2 respondents (5.9%) are good, 14 respondents (41.2%) are sufficient, while 18 respondents (52.9%) are lacking.

DISCUSSION
Most of the behavior of young women regarding reproductive health needs to be improved in the number of 22 respondents (64.7%) and good in the number of 3 respondents (8.8%). Adolescence is a time of rapid changes in the process of physical, cognitive, psychosocial/behavioral, and hormonal growth. The flow of information that is increasingly sweeping the world has inevitably changed the views and sexual behavior of Indonesian adolescents, resulting in deviations that lead to the fading of norms in society that are related to their reproductive health (Soetjiningsih, 2014). Things that influence a person's behavior lie within the individual/internal factors, from outside himself/external factors, driven by the activity of the organism's system and response to stimuli (Goddess, 2020).
According to the researcher's assumption, to increase adolescents' knowledge and behavior about motivation to carry out premarital examinations properly and correctly is to provide health education/health promotion. Health promotion is important because the information provided contains knowledge and messages to adolescents to avoid getting caught up in the wrong associations. Lack of knowledge and attitudes can lead to cases such as cervical cancer. Another impact occurs when there is a problem and one has to be admitted to the hospital. The service mechanism must be maximized, including during the initial nursing assessment .
Based on table 4 shows that most of the motivation to carry out premarital health checks is lacking in the number of 18 respondents (52.9%), and the good ones are in the number of 2 respondents (5.9%). Motivation is the encouragement or stimulus that makes a person do the work he wants voluntarily without feeling forced so that the work can go well or produce something satisfying. Wahyudi & Tupti, 2019). The motivation to carry out pre-marital or pre-pregnancy health checks is becoming increasingly important, bearing in mind that the rate of information increasingly influencing the world has become the cause of society's revolution in assessing premarital sex (Wati et al., 2021).
Entering the teenage years, several types of hormones, especially the hormones estrogen and progesterone, begin to play an active role so that in girls, breasts begin to grow, hips widen and enlarge so they don't look like small children anymore. In addition, there will be changes in secondary sex characteristics. Primary sex characteristics are marked by the start of the functioning of the male and female reproductive organs. In women, the primary sex characteristics are marked by the arrival of menarche (Proverawati & Misaroh, 2015).
Globalization has resulted in rapid social changes, including increased behavior of premarital sex, unwanted pregnancies, and abortion practices that can lead to death. The low fulfillment of reproductive rights can be seen by the still high maternal mortality rate (MMR), the infant mortality rate (IMR), and the under-five-year mortality rate (AK under-five). The high MMR and the low understanding of reproductive health are indicators of the government's weakness in protecting, respecting, and fulfilling citizens' rights to reproductive health (Hasanah, 2016). Health aspects must be evenly distributed, including in daily life in the work environment and community .
Reproductive health is physical, mental, and social well-being in all matters related to systems, functions, and reproductive processes, not just conditions free from disease or disability (Kusmiran, 2011). According to the researchers' assumption that the reproductive health problems that are likely to be experienced by adolescents include unwanted pregnancies (KTD), abortion, sexually transmitted diseases (STDs), sexual violence, and problems with limited access to information and health services. Limited access to information for adolescents regarding reproductive health, which includes sexuality. The effect of this limitation in hospital services can cause patient satisfaction to decrease .
It can be seen that of the 34 respondents, most of the behavior of young women regarding reproductive health was lacking 22 respondents (64.7%), sufficient for nine respondents (26.5%), and good for three respondents (8.8%), while the motivation to do a premarital examination, namely two respondents (5.9%), enough 14 respondents (41.2%). In comparison, those who lacked were 18 respondents (52.9%) Based on the results of the analysis of Spearman, it was obtained p=0.002 that there is a relationship between female adolescent behavior regarding reproductive health with the motivation to carry out premarital health checks in Gading Kulon Probolinggo Village in 2022. With a large enough number of adolescents, adolescents, as the nation's next generation, need to be prepared to become healthy human beings. physical, spiritual, mental, and spiritual. Adolescence is a transition period from childhood to adulthood marked by various physical, psychological, and social changes. Various changes that occur in these adolescents can cause problems that might interfere with the development of adolescents in the future.

CONCLUSION
Most of the behavior of young women regarding reproductive health needs to be improved. Most of the motivation to do premarital health checks needs to be improved. There is a relationship between the behavior of young women regarding reproductive health and the motivation to carry out premarital health checks in Gading Kulon Village, Probolinggo, and Probolinggo Regency. Therefore, the existence of youth groups must be addressed.