Nursing in Practice Summer 2022 | Page 40

40 | Nursing in Practice | Summer 2022
HOW TO

Contraception in the under-18s

Sexual health specialist nurse Jodie Crossman advises on how to support under-18s with access to contraception
Over the past two decades, pregnancy rates in under-18s have fallen steadily, with the teenage conception rate reaching an all-time low of 13 per 1,000 in 2020. 1 Unfortunately, rates of sexually transmitted infections( STIs) have not followed this trend, and young people still carry a disproportionate burden of diagnosis. 2
To address this STI rate, and continue the reduction in unintended pregnancies, all clinicians have a role in discussing contraception and condom use with under-18s who access their services. This article will explain the key points to consider when undertaking these discussions.
As ever, when discussing contraception and sexual health, it is important not to assume all patients with a uterus or vagina identify as female. Asking a patient’ s pronouns at the start of a consultation can help guide the discussion and reassure you that you are providing a safe space for young people to be themselves.
What are the laws around young people and contraception? The age of consent( when a person can legally consent to sex) in the UK is 16, but approximately one-third of young people will have engaged in sexual activity by this age. 3 Mutually consenting sexual activity between two under-16s is unlikely to be prosecuted, although children aged under 13 are legally considered to be unable to consent to sex. 4 The legal guidance for confidentiality and consent varies across the devolved nations, but a detailed framework for the UK can be found in the General Medical Council guidance for under-18s. 5
Specific guidance exists for contraceptive and sexual health services, where maintaining confidentiality is key to encouraging young people to attend and engage with clinicians. Services offering STI testing and contraception are also important in helping prevent sexual exploitation and abuse of young people. However, confidentiality has to be balanced against safeguarding needs. Sexual health services use Fraser guidelines 6( see Box 1), and a person aged under 16 should be judged to meet these guidelines by the clinician in order to access services alone. Gillick competency assessment may also be used.
How should a safeguarding assessment be done? Although over-16s do not need to meet the Fraser criteria to access care, any young person may be at risk of child sexual exploitation( CSE). All staff regularly seeing
A consultation on contraception can be a rare chance to discuss a young person’ s life and identify concerns
Box 1 Fraser guidelines 6
Under the Fraser guidelines, practitioners should be satisfied of the following:
• The young person cannot be persuaded to inform their parents or carers that they are seeking this advice or treatment( or to allow the practitioner to inform their parents or carers).
• The young person understands the advice being given.
• The young person’ s physical or mental health, or both, are likely to suffer unless they receive the advice or treatment.
• It is in the young person’ s best interests to receive the advice, treatment or both without their parents’ or carers’ consent.
• The young person is very likely to continue having sex with or without contraceptive treatment.
ALAMY