Reproductive Health in Hungary
Zoltàn Borthaiser, Attila Kereszturi
in collaboration with the
Geneva WHO Collaborating Centre for Research in Human Reproduction
List of annexes
Annex 1 - Population in Hungary
Annex 2 - Outcome of pregnancies in Hungary
Annex 3 - Maternal mortality in Hungary
The mother and infant health care has an old tradition in Hungary. Igancz Semmelweis was the first well-known physician who strove to defeat puerperal sepsis. The first easy-to-survey obstetrical statistics were initiated by Vilmos Tauffer in 1892. This statistical methods have served as a basis for Hungarian obstetrical statistics for more than one hundred years.
During the socialist government many laws and programs were created to
increase the birth rate, but have only been partially successful. Most of
these laws are still valid e.g. :maternity support, child welfare support
etc. The unequal socio-economic status within the Hungarian population was
more obvious after the break up of the socialist regime and this decreased
its influence on reproductive health in Hungary. Nowadays, one part of the
population is living in good social conditions,similar to western-Europeans.
civil. The other part of Hungarian population lives in low social conditions,
mostly in villages.
The number of live births (LB) decreased significantly in the last few years in Hungary. This is probably due to the financial uncertainty of families who formed during the change of the regime. The extensive decrease of LB appears in the population belonging to a higher socioeconomic status. Families with one or two children are common in this group. Big families (6-8 children) are not rare in the lower socioeconomic population group. This is based on the ethnical traditions. This process has just weakened the financial position of these families and the state has been in charge for the up-bringing and education of some of these children.
Nowadays, the number of the Hungarian population is decreasing. In 1990, 10.374.823 inhabitants were reported, in 1997 this number decreased to 10.174.442 (Annex 1). The number of LB decreased in the population, this can be seen in the number of LB per 1.000 inhabitants (Annex1). The percentage of women at reproductive age (WRA: women 15-49 years old) is about 25% of the total population (Annex1 ). The increasing number of elderly people is one of the characteristics of Hungarian population.
In Hungary, the female life expectancy at birth was 74.7 yr. and male life expectancy at birth was 66.06 years in 1996 and women are already emancipated in legal, cultural and educational aspects.
The rather unhealthy nourishment and the insufficient physical exercise are important characteristics of Hungarian people. This is valid for the population of WRA as well.
The treatment of diseases which are due to the unhealthy life style (cardiovascular diseases, obesity, diabetes mellitus) are the most serious medical problems in Hungary.
The increase population size has been supported by the Hungarian government by introducing laws which tended to increase the population number and financially support families with children, mainly with children less than 14 years old. The place of a professional mother is established: mothers who have three or more children receive a salary. However, we can feel some discrepancy between these laws and the health service. The health establishments are financed from the fund of Health Insurance in Hungary. Only the treatment of diseases is covered by the Health Insurance which excludes pregnancy. Therefore, Hungarian women have to pay for interruption of pregnancy, for sterilisation, contraceptive pills and IUDs. It was discussed that the Health Insurance wants to stop financing prenatal care. This has to be considered a very dangerous process, taking into account that many pregnant women will not be able to cover the expenses for antenatal care and will therefore not attend the clinics.
First level care:The services which provide RH are spread in the whole health institution network of the country. They involve:
Second level care
District hospitals with obstetric/gynecology and paediatric departments
Third level care
University hospital with obstetrics/gynecology and pediatric departments
More than 94% of the pregnant women in Hungary attend antenatal care services. The prenatal care services assessing pregnant women, are found in every big area with mobile services available in smaller villages. Attendency of prenatal care service is not compulsory, but financial support for the mother will be paid if she visits antenatal care clinic. Screening for gestational diabetes, FPH gestosis, IUGR and other risc factors are performed by the Perinatal Care Service and women will be treated by the second level of RH if necessary. Fetal monitoring is a routine task provided by the clinic.
There is close co-operation between this system and the Visiting Nurse Service (VNS) in Hungary. The VNS was founded in 1916. The nurses prepare the pregnant women for their delivery and they instruct the women on infant-care and child welfare.
Maternal mortality ratio, being one of the most sensitive indicators of women’s health, is one of the lowest in Central and Eastern Europe (Annex 3). In 1996, 33% of all maternal deaths were due to abortions.
The modern FP methods are well known and accepted in Hungary. There exist only partial or estimated data because there are no national statistics about the use of contraceptive methods in Hungary. The OC is the most wide-spread method in the whole country. A increase in IUD use has been observed, because the women are often afraid of OC complications. The increased use of condoms is likely due to the AIDS-propaganda and recently the use of traditional or natural methods is more preferred. Oral contraceptives are only available in clinics and pharmacies. IUD insertion is only performed in hospitals, and sterilisation is strictly only permitted for men and women over 40 years of age, for those over 35 years with three children, or over 30 years with four children.
Interruption of pregnancy is legal and performed upon request up to 12 weeks of pregnancy, if there is a risk to the woman’s life, a risk of having a disabled child and in case of an unwanted pregnancy. Abortion is performed up to 24 weeks of pregnancy if there is an acute risk for the woman’s life or intrauterine death or suspected genetic defect. An abortion costs about US $ 60. The law on legal abortion stipulates that abortion is not a family planning method.
77.000 abortions are officially induced during one year. 15 % of all abortions in Hungary are performed in adolescent girls (14-19 years) (Annex 2). The method of interruption of early pregnancies (less than 12 weeks) are dilatation and aspiration.
99% of births are assessed by trained medical staff in Hungary. Recently, there was a claim to family delivery, mainly in big cities. The hospitals and other delivery rooms are prepared also for the presence of the father or other members of family during the birth process. Home-delivery is not widely practised.
The perinatal mortality rate is decreased in the last years (Annex 2). This result is due to a the work of the Prenatal Care Service and delivery rooms. The data of the perinatal mortality rates are not comparable with other countries statistics, because in Hungary the perinatal period was defined as starting from 28 weeks of gestation till the 7th day of life.
The number of new-borns with low birth weight (less than 2500 grams) also decreased in the last few years (Annex 2). The duration of hospital staying for healthy babies is usually 5 days. The babies usually stay inneonatal departments which are in close connection with the delivery rooms. Babies with different pathologies or congenital problems are transferred to the regional perinatal intensive centres.
Breast, colon and rectum cancer have the highest morbidity in women in Hungary. All women examined by gynaecologists are also screened for cervical cancer, as the gynaecologist is obliged to take a cytological smear. This has helped to diagnose this malignant pathology at an early stage, even in symptom-free patients. The services that provide screening of genital cancers are placed in specialised polyclinics of some cities of the country, in gynaecological hospitals and in services of gynaecological oncology.
The care for women after menopause is performed in the outpatient clinics for menopausal women, at the first level of the health care system.
Proportion of women in reproductive age (15-49 years)
Life expectancy at birth (in years)
Induced abortions in Hungary
Perinatal mortality rate
Low birthweight infants in Hungary
Maternal mortality rate = number of maternal deaths/100000 women 15-19
Maternal mortality ratio as obstetric risk = number of maternal deaths/100000 live births
Maternal mortality ratio as risk of pregnancy = number of maternal deaths/100000 pregnancies
* deaths caused by complications of pregnancy, abortion, delivery and puerperium.
Edited by Aldo Campana,