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 |