PREVALENCE, AVAILABILITY AND ACCESSABILITY OF IUD IN HUNGARY

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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

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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. 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
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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 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)

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PREVALENCE OF IUD USE WORLDWIDE (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
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AVAILABILITY OF IUD IN HUNGARY I.
MLCu 250/375 (Mona Lisa)
X not available anymore (non-medicated)
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AVAILABILITY OF IUD IN HUNGARY II.

• 2. Where to get it?
• pharmacies (Mirena is exclusively available
  here)
• company sales (directly or through
  distributors)
• physicians 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)

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ACCESSABILITY OF IUD IN HUNGARY I.

• 1. Legal restrictions
• nulligravidas (sometimes neglected)
• only gynecologists are allowed to insert
• insertion in centers with lying-in background
  (?)
• (nowadays neglected)

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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 as emergency contraception

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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)

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CONCLUSIONS I.

• Hungary was pioneer for IUD use in the
  1960s, and has a good position even nowadays
  as for inventions (see alloy devices)
• Prevalence
• although acceptable (14), but it could
  further be increased through eliminating or
  decreasing the restrictive and limiting
  factors

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CONCLUSIONS II.

• Availability
• market has a wide choice of IUDs, but new
  types are welcomed
• devices are easy to get (pharmacies, clinics)
• positive attitude needs to be increased
  (correct information, postabortal insertion,
  emergency contraception)

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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