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In Reply: Drs Last and Wilson believe that it is counterintuitive to promote increased access to EC because of our failure to demonstrate a decreased pregnancy rate among women with advance provision of EC. However, we believe that it is important to distinguish between EC efficacy, which is the protection that users would receive under ideal conditions, and EC effectiveness, which is the protection it provides under actual or typical conditions. Efficacy depends on properties of the product, such as impact on ovulation. Effectiveness depends not only on properties of the product but also characteristics of the user, such as frequency of unprotected intercourse.

Levonorgestrel EC has been estimated to be at least 49% effective (95% confidence interval, 17%-69%) in reducing the risk of unintended pregnancy after a single act of unprotected intercourse.¹ In our study, almost half of the women who received an advance provision of EC reported . . . [Full Text of this Article]

Tina R. Raine, MD, MPH
rainet@obgyn.ucsf.edu

Cynthia C. Harper, PhD
Center for Reproductive Health Research and Policy
Department of Obstetrics, Gynecology and Reproductive Sciences
University of California, San Francisco