Under-16 contraception — confidentiality and safeguarding

PLAB 2 · obs-gyn · hard · 8 minutes

Candidate brief

You are a doctor in a GP practice. Emily Jones, aged 15, has attended alone requesting contraception. She does not want her parents informed. Assess her understanding, confidentiality and safeguarding needs, and discuss an appropriate sexual-health and contraception plan. No physical examination is required.

What examiners look for

Gillick competence and the Fraser criteria are related but not identical. Gillick competence assesses whether a person under 16 has enough maturity and understanding to make the particular healthcare decision. The Fraser criteria apply specifically when providing contraception or sexual-health treatment without parental knowledge or consent. Explain confidentiality before taking a sexual history. Do not promise absolute secrecy. Encourage involvement of a parent, carer or trusted adult, but do not make this a condition of receiving confidential care when the young person is competent and the Fraser criteria are met. Assess every relationship individually for coercion, exploitation, age or power imbalance, a position of trust, payment, drugs, alcohol, threats and online abuse. Sexual activity under 16 does not automatically require disclosure in every case. Sexual activity involving a child under 13 or abusive or seriously harmful circumstances will normally require information-sharing and safeguarding action. Offer unbiased information about all medically suitable methods, including long-acting reversible contraception. Condoms remain important because most contraceptive methods do not protect against STIs. Assess pregnancy and STI risk, offer relevant testing and emergency contraception when indicated, and document the complete decision-making process.

Guideline references

Practise this station

Role-play it with an AI patient and get feedback against the full marking scheme. Create a free account — 3 stations per month free.