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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,

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Presentation on theme: "PREVALENCE, AVAILABILITY AND ACCESSABILITY OF IUD IN HUNGARY I. Batár Department of Obstetrics and Gynecology University of Debrecen, Hungary 7th ESC SEMINAR,"— Presentation transcript:

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

2 Sept 2003I.B. * 7th ESC Seminar, Budapest2 SHORT HISTORY OF IUD Cornerstone international and Hungarian events 1909Dr. Richard Richter (Germany): dried silkworm gut 1923Dr. Karl Pust (Germany): similar device with tail 1929Dr. Ernst Gräfenberg (Germany): Gräfenberg ring 1934Dr. T. A. Ota (Japan): Ota ring 1959Reconsideration of IUD use (Oppenheimer/IL, Ishihama/J) 1960Dr. Lazar Margulies (USA): Margulies spiral 1962Dr. Jack Lippes (USA): Lippes loop (Gold Standard!) 1965Dr. Ferenc Szontágh (Hungary): Szontágh IUD (plastic) 1972Szontágh IUD marketed in Hungary after clinical trials 1074Limited number of TCu 200 IUD for clinical trials 1970s-1980s Clinical trials with new IUDs in designated centers 1990sWide range of devices became available in Hungary

3 Sept 2003I.B. * 7th ESC Seminar, Budapest3 PREVALENCE OF IUD USE IN HUNGARY I. 1970s – 1980s: exact figures (all-country reporting system) insertions/year (minus illegal export to Romania?) 1990s – 2000s: no central recording, only estimations Marketing surveys: insertions/year (Schering) Contraceptive survey/demographic data: a) IUD use: 14% of married women in reproductive age b) N o of married women in reproductive age (2001): 1.3 M c) Calculated number of users: d) If changed every 5 (?) years: insertions/year (?) (plus non married women) IUD is the second in the rank of methods next to the pill (33%)

4 Sept 2003I.B. * 7th ESC Seminar, Budapest4 PREVALENCE OF IUD USE WORLDWIDE (1998)* Country/RegionPercentage of women of reproductive age Contraception total IUD Rank # Hungary WORLD USA (min) Finland (max) Moldova (max) Less developed regions More developed regions CEEC Northern Europe Western Europe Southern Europe * Source: UN

5 Sept 2003I.B. * 7th ESC Seminar, Budapest5 AVAILABILITY OF IUD IN HUNGARY I. MLCu 250/375 (Mona Lisa) x Szontágh IUD TCu 200 TCu 380 GyneFix Nova T 380 Mirena * = available in three sizes Plastic = no metal content 1. Types of devices Utering SilverLily/GoldLily SilverLily-Zn/Plastic* Alloy IUDs: Nova T X = not available anymore (non-medicated)

6 Sept 2003I.B. * 7th ESC Seminar, Budapest6 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)

7 Sept 2003I.B. * 7th ESC Seminar, Budapest7 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)

8 Sept 2003I.B. * 7th ESC Seminar, Budapest8 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

9 Sept 2003I.B. * 7th ESC Seminar, Budapest9 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)

10 Sept 2003I.B. * 7th ESC Seminar, Budapest10 CONCLUSIONS I. Hungary was pioneer for IUD use in the 1960s, and has a good position even nowadays as for inventions (see alloy devices) Hungary was pioneer for IUD use in the 1960s, and has a good position even nowadays as for inventions (see alloy devices) Prevalence: Prevalence: although acceptable (14%), but it could further be increased through eliminating or decreasing the restrictive and limiting factors although acceptable (14%), but it could further be increased through eliminating or decreasing the restrictive and limiting factors

11 Sept 2003I.B. * 7th ESC Seminar, Budapest11 CONCLUSIONS II. Availability: 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)

12 Sept 2003I.B. * 7th ESC Seminar, Budapest12 CONCLUSIONS III. Accessibility: 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


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