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PREVALENCE, AVAILABILITY AND ACCESSABILITY OF IUD IN HUNGARY

PREVALENCE, AVAILABILITY AND ACCESSABILITY OF IUD IN HUNGARY. I. Bat á r Department of Obstetrics and Gynecology University of Debrecen, Hungary 7th ESC SEMINAR , September 12 - 13, 2003 Budapest, Hungary. SHORT HISTORY OF IUD Cornerstone international and Hungarian events.

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PREVALENCE, AVAILABILITY AND ACCESSABILITY OF IUD IN HUNGARY

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  1. PREVALENCE, AVAILABILITY AND ACCESSABILITY OF IUD IN HUNGARY I. Batár Department of Obstetrics and Gynecology University of Debrecen, Hungary 7th ESC SEMINAR,September 12 - 13, 2003 Budapest, Hungary

  2. SHORT HISTORY OF IUD Cornerstone international and Hungarian events 1909 Dr. Richard Richter (Germany): dried silkworm gut 1923 Dr. Karl Pust (Germany): similar device with tail 1929 Dr. Ernst Gräfenberg (Germany): Gräfenberg ring 1934 Dr. T. A. Ota (Japan): Ota ring 1959 Reconsideration of IUD use (Oppenheimer/IL, Ishihama/J) 1960 Dr. Lazar Margulies (USA): Margulies spiral 1962 Dr. Jack Lippes (USA): Lippes loop (Gold Standard!) 1965 Dr. FerencSzontágh (Hungary): Szontágh IUD (plastic) 1972 Szontágh IUDmarketed in Hungary after clinical trials 1074 Limited number of TCu 200 IUD for clinical trials 1970s-1980s Clinical trials with new IUDs in designated centers 1990s Wide range of devices became available in Hungary I.B. * 7th ESC Seminar, Budapest

  3. PREVALENCE OF IUD USE IN HUNGARY I. • 1970s – 1980s: exact figures (all-country reporting system) • 50.000 - 60.000 insertions/year • (minus illegal export to Romania?) • 1990s – 2000s: no central recording, only estimations • Marketing surveys: 35.000-40.000 insertions/year(Schering) • Contraceptive survey/demographic data: • a) IUD use: 14% ofmarried women in reproductive age • b) No of married women in reproductive age (2001): 1.3 M • c) Calculated number of users: 177.000 • d) If changed every 5 (?) years: 35.000 insertions/year (?) • (plus non married women) • IUD is the second in the rank of methods next to the pill (33%) I.B. * 7th ESC Seminar, Budapest

  4. PREVALENCE OF IUD USEWORLDWIDE (1998)* Country/Region Percentage of women of reproductive age Contraception total IUD Rank # Hungary 73 14 2 WORLD 58 13 3 USA (min) 59 1 6 Finland (max) 80 29 2 Moldova (max) 74 38 1 Less developed regions 55 14 2 More developed regions 70 6 5 CEEC 67 16 2 Northern Europe 78 18 3 Western Europe 75 9 3 Southern Europe 68 4 4 * Source: UN I.B. * 7th ESC Seminar, Budapest

  5. 1. Types of devices xSzontágh IUD Nova T TCu 380 TCu 200 Alloy IUDs: SilverLily/GoldLily SilverLily-Zn/Plastic* Utering GyneFix * =available in three sizes Plastic = no metalcontent Nova T 380 Mirena AVAILABILITY OF IUD IN HUNGARY I. MLCu 250/375 (Mona Lisa) X= not available anymore (non-medicated) I.B. * 7th ESC Seminar, Budapest

  6. AVAILABILITY OF IUD IN HUNGARY II. • 2. Where to get it? • pharmacies (Mirena is exclusively available here) • company sales (directly or through distributors) • physician’s office (mainly in private praxis) • 3. When to insert? • interval (usually on cycle days 1-7) • post abortion (not everywhere accepted) • post partum (6-8 weeks following delivery) • post placental (limited number of cases in clinical trials; • no suitable devices are available) • post coital (emergency contraception: not well known) I.B. * 7th ESC Seminar, Budapest

  7. ACCESSABILITY OF IUD IN HUNGARY I. • 1. Legalrestrictions • nulligravidas (sometimes neglected) • only gynecologists are allowed to insert • insertion in centers with lying-in background (?) • (nowadays neglected) I.B. * 7th ESC Seminar, Budapest

  8. ACCESSABILITY OF IUD IN HUNGARY II. • 2. Medical (ob/gyn) limitations • „optimal for those with completed family size” • „suggested after the second child” • side effects/problems are more publicized • than benefits • not widely known asemergency contraception I.B. * 7th ESC Seminar, Budapest

  9. ACCESSABILITY OF IUD IN HUNGARY III. • 3. Financial limitations • not subsidized by the health insurance • (since 1993) • high price (compared to salary; the cheapest!) • not exempted for VAT (12%  25%!) • “punishment” instead of support • indirect effect (IUD use has not been a • medical indication for abortion since 1993) I.B. * 7th ESC Seminar, Budapest

  10. CONCLUSIONS I. • Hungary was pioneer for IUD use in the 1960s, and has a good position even nowadays as forinventions (see alloydevices) • Prevalence: • although acceptable (14%), but it could further be increased througheliminatingordecreasing the restrictive and limiting factors I.B. * 7th ESC Seminar, Budapest

  11. CONCLUSIONS II. • Availability: • market has a wide choice of IUDs, but newtypes are welcomed • devices are easy to get(pharmacies, clinics) • positive attitude needs to be increased (correct information,postabortal insertion, emergency contraception) I.B. * 7th ESC Seminar, Budapest

  12. CONCLUSIONS III. • Accessibility: • eliminating legal restrictions (gravidity/parity, who/where to insert) • decreasing medical barriers through CME • modifying health care, social and taxation policy to reduce prices I.B. * 7th ESC Seminar, Budapest

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