A 15 year old girl is requesting for oral contraceptive pills (OCP) as she is sexually active. She refuses to tell her parents about her sexual activity and mentions that her partner is a 38 year old man. What is the SINGLE most appropriate action?
A. Breach confidentiality and inform authorities
B. Advise them about safe sex and prescribe the pill
C. Perform an STI screen
D. Inform her that she can only be prescribed the pill after the age of 16
E. Inform her that she can only be prescribed the pill after the age of 18
Under the Fraser guidelines, a competent young person may be given advice on contraception. However, this man is much older than her. Thus, you would need to share information regarding this and breach confidentiality.
If her sexual partner was of similar age, example 15 years old, and she had the maturity to understand the advice and its implications, you should then advise them about safe sex, prescribe the COCP and do not breach confidentiality.
Breaching confidentiality in sexually active young person
Under the Fraser guidelines, you can provide contraceptive, abortion and STI advice and treatment, without parental knowledge or consent, to young people under 16 provided that: - They understand all aspects of the advice and its implications - You cannot persuade the young person to tell their parents or to allow you to tell them - In relation to contraception and STIs, the young person is very likely to have sex with or without such treatment - Their physical or mental health is likely to suffer unless they receive such advice or treatment, and - It is in the best interests of the young person to receive the advice and treatment without parental knowledge or consent
However, you should share information about abusive or seriously harmful sexual activity involving any child or young person, including that which involves: - A young person too immature to understand or consent - Big differences in age, maturity or power between sexual partners - A young person’s sexual partner having a position of trust - Force or the threat of force, emotional or psychological pressure, - Bribery or payment, either to engage in sexual activity or to keep it secret - Drugs or alcohol used to influence a young person to engage in sexual activity when they otherwise would not - A person known to the police or child protection agencies as having had abusive relationships with children or young people.