A PREGNANT 14-YEAR-OLD

Ryan has broken the Sexual Offences Act (2003) by having sexual intercourse with a young person under 16 years. However, the Act aims to reduce sexual exploitation and abuse of children and young people, not to criminalize normal adolescent behaviour. If all young people known to be sexually active were reported to the police, they would probably be less likely to access contraceptive and sexual health services, leaving them more vulnerable to unintended pregnancy and other health risks. Under the Act, all those under 16 have the right to confidential advice, and the person offering it, med ical or non-medical, is not guilty of any offence, provided they are protecting the child’s physical and/or emotional well-being. The key words are ‘exploitation’ and ‘abuse’, and in the rare event of these being present, the patient must understand that absolute confidentiality cannot be guaranteed. To determine whether a relationship presents a risk that needs referral to Social Care and/or police, the GP needs to consider:

• whether the young person is competent to understand and consent to the sexual activity – according to the Act, children under 13 are not and anyone involved in penetrative sex can be convicted of rape

• power imbalances through differences in size, age and development – even 16 and 17-year-olds cannot give informed consent if the perpetrator is in a position of trust, such as a teacher or youth worker

• whether there was aggression, manipulation or bribery including the use of drugs and/or alcohol

• attempts to secure unreasonable secrecy

• whether the partner is known by agencies to have worrying relationships with other young people • evidence of parental neglect or lack of supervision in a child under 13

• whether the relationship involves behaviours considered to be ‘grooming’ in the context of sexual exploitation.

From Anna’s history there are no obvious legal or safeguarding children’s anxieties about her relationship with Ryan, although it is far from ideal. Therefore the GP does not have to report it to anyone. In UK law the legal age of consent to medical treatment is 16 years. There is a legal precedent for younger children to give valid consent provided they fulfil approved criteria. To be ‘Gillick’ competent they must demonstrate sufficient maturity and intelligence (capacity) to understand the nature and implications of the proposed treatment, including the risks and alternatives, and the consequences of not having it. This means that Anna could have a termination without her parents’ (or her boyfriend’s) knowledge, although she should be actively encouraged to tell them. Note that a child is not considered to have the capacity to refuse investigation or treatment against the judgment of their parents or doctors. A 15-year-old cannot refuse blood tests or treatment, although every effort should be made to understand their fears and wishes.

KEY POINTS

• All children under 16 years have the right to confidential sexual health advice.

• Only where there is evidence of exploitation or abuse should cases of underage sex be referred to Social Care and/or police.

• Young people can, under specific circumstances, consent to treatment independently of their parents but they should always be encouraged to involve them.