Reducing the number of pregnancies and sexually transmitted infections (STIs) among those aged under 16 is a government priority due to rising numbers of both (Department of Health, 1999; 2001; Social Exclusion Unit, 1999). Contraceptive nurses have a key role as they are in a unique position to give clients the opportunity to talk about intimate areas of their sexual life and anxieties in a non-judgemental environment (Everett, 1998). Most agencies offering information, advice or services on sexual health to under-16s use the Fraser Guidelines (DHSS, 1986) as a framework for best practice. These are summarised in Box 2 (p36). New guidance has been issued by the DoH (2004), highlighting for the first time that where a young person under 16 years of age requests contraception, doctors and other health professionals should give him or her the time and support to make an informed choice. Although the Fraser Guidelines were issued immediately after the House of Lords judgement in the Gillick case, and are now almost 20 years old, the new guidance does not change the legal framework established in the Gillick case - that health professionals are justified in giving confidential contraceptive advice and treatment to under-16s, provided certain conditions are met. The Royal College of General Practitioners and Brook (2000) advise that young people being exploited or abused may need counselling. Nurses should always ask young people whether sex is consensual and who and what age their partner is, and are advised to look out for signs of coercion, exploitation or abuse (DoH, 2003).
Young people may disclose abuse by family members or friends to nurses (DoH, 2003). In such cases it is vital to follow child protection protocols and involve the young person in the process of informing the necessary authorities (DoH, 1999).
Since very young people do engage in sexual activity, whether consensual or not, it is preferable to make services open to all ages (DoH, 2003). It...
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