Transcript Four Year Clinical Experiences with Two New Copper

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