prevalence, availability and accessability of iud in hungary i. batár department of obstetrics and...
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PREVALENCE, PREVALENCE, AVAILABILITY AND AVAILABILITY AND
ACCESSABILITY OF IUD IN ACCESSABILITY OF IUD IN HUNGARYHUNGARY
I. BatárDepartment of Obstetrics and Gynecology
University of Debrecen, Hungary
7th ESC SEMINAR, September 12 - 13, 2003Budapest, Hungary
Sept 2003 I.B. * 7th ESC Seminar, Budapest 2
SHORT SHORT HISTORY OF IUDHISTORY OF IUDCornerstone international and Hungarian Cornerstone international and Hungarian
eventsevents1909 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. Ferenc Szontágh (Hungary): Szontágh IUD (plastic)
1972 Szontágh IUD marketed 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
Sept 2003 I.B. * 7th ESC Seminar, Budapest 3
PREVALENCEPREVALENCE OF IUD OF IUD USE USE IN IN HUNGARYHUNGARY I. 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% of married 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%)
Sept 2003 I.B. * 7th ESC Seminar, Budapest 4
PREVALENCEPREVALENCE OF IUD OF IUD USE USE WORLDWIDEWORLDWIDE (1998)* (1998)* Country/Region Percentage of women of reproductive ageContraception total IUD
Rank #Hungary 73 14 2WORLD 58 13 3 USA (min) 59 1 6 Finland (max) 80 29 2 Moldova (max) 74 38 1Less developed regions 55 14 2More developed regions 70 6 5CEEC 67 16 2Northern Europe 78 18 3Western Europe 75 9 3Southern Europe 68 4 4
* Source: UN
Sept 2003 I.B. * 7th ESC Seminar, Budapest 5
AVAILABILITY OF IUD IN HUNGARYAVAILABILITY OF IUD IN HUNGARY I. I.
MLCu 250/375
(Mona Lisa)
x Szontágh IUD TCu 200 TCu 380
GyneFix
Nova T 380 Mirena * = available in three sizesPlastic = no metal content
1. Types of devices
Utering
SilverLily/GoldLilySilverLily-Zn/Plastic*
Alloy IUDs:
Nova T
X = not available anymore (non-medicated)
Sept 2003 I.B. * 7th ESC Seminar, Budapest 6
AVAILABILITY OF IUD IN HUNGARYAVAILABILITY OF IUD IN HUNGARY IIII..
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)
Sept 2003 I.B. * 7th ESC Seminar, Budapest 7
AACCESSCCESSABILITY OF IUD IN HUNGARY ABILITY OF IUD IN HUNGARY I.I.
1. Legal restrictions
• nulligravidas (sometimes neglected)
• only gynecologists are allowed to insert
• insertion in centers with lying-in background (?)
(nowadays neglected)
Sept 2003 I.B. * 7th ESC Seminar, Budapest 8
AACCESSCCESSABILITY OF IUD IN HUNGARY ABILITY OF IUD IN HUNGARY II.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 as emergency contraception
Sept 2003 I.B. * 7th ESC Seminar, Budapest 9
AACCESSCCESSABILITY OF IUD IN HUNGARY ABILITY OF IUD IN HUNGARY III.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)
Sept 2003 I.B. * 7th ESC Seminar, Budapest 10
CONCLUSIONS I.CONCLUSIONS I.
• Hungary was pioneer for IUD use in the Hungary was pioneer for IUD use in the 1960s, and has a good position even 1960s, and has a good position even nowadays as fornowadays as for inventions inventions (see alloy(see alloy devices)devices)
• Prevalence: Prevalence: although acceptablealthough acceptable (14%) (14%), but , but it it could could further be increased throughfurther be increased through eliminatingeliminating oror
decreasing the restrictive and limiting decreasing the restrictive and limiting factorsfactors
Sept 2003 I.B. * 7th ESC Seminar, Budapest 11
CONCLUSIONS II.CONCLUSIONS II.
• Availability:Availability:
- market has market has a a wide choice of IUDs, but wide choice of IUDs, but newnew types are welcomedtypes are welcomed- devices are easy to getdevices are easy to get ((pharmacies, clinicspharmacies, clinics))
- positive attitude needs to be increased positive attitude needs to be increased (correct information,(correct information, postabortal insertion, postabortal insertion, emergency contraception)emergency contraception)
Sept 2003 I.B. * 7th ESC Seminar, Budapest 12
CONCLUSIONS III.CONCLUSIONS III.
• Accessibility:Accessibility:
- eliminating legal restrictions eliminating legal restrictions (gravidity(gravidity//parity, who/where to insert)parity, who/where to insert)- decreasing medical barriers through decreasing medical barriers through CMECME- modifying health caremodifying health care, social, social and and taxation policy to reduce prices taxation policy to reduce prices
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