When providing contraception to young people, take account of:

• Communication of the level of confidentiality [FFPRHC, 2004b]:
• Inform young people seeking contraceptive advice and services that confidentiality is to be expected from all members of the healthcare team, but that other professionals, such as teachers and youth workers, may not have the same duty of confidentiality.
• Inform a young person under 16 years of age in advance that confidentiality might be broken if maltreatment, exploitation, or coercion is suspected:
• If information is to be shared or confidentiality breached, the young person will be informed and her consent sought.
• Consent is not essential if the disclosure is justified.
• The timing of any reporting or breach of confidentiality will be carefully considered.
• Legal and ethical issues:
• The legal age of consent to sexual activity is 16 years in Scotland, England, and Wales, and 17 years in Northern Ireland. Sexual activity under the age of consent is an offence even if consensual and is considered more serious (statutory rape) when the person is less than 13 years of age [FFPRHC, 2004b].
• In England and Wales, it is lawful to provide contraceptive advice and treatment to girls under the age of 16 years without parental consent, provided that the healthcare professional is satisfied that the Fraser guidelines have been met [Teenage Pregnancy Unit, 2001; FFPRHC, 2004b; Wheeler, 2006].
• The Fraser guidelines are a set of criteria which must be fulfilled when contraceptive services are provided to people less than 16 years of age without their parent's knowledge or permission:
• The young person understands the advice given to her by the health professional.
• The young person cannot be persuaded to inform her parents, or to allow the health professional to inform them.
• It is likely that the young person will continue to have sexual intercourse, with or without the use of contraception.
• The young person's physical or mental health may suffer as a result of withholding contraceptive advice or treatment.
• It is in the best interests of the young person for the clinician to provide contraceptive advice or treatment, or both, without parental consent.
• In Scotland, similar criteria apply under The Age of Legal Capacity Act 1991. The Act appears to assign more legal rights to children under 16 years of age, in that parental responsibility cannot authorize procedures that a competent child has refused [Sterrick, 2006; Wheeler, 2006].
• Consider child protection issues, including the possibility of exploitation or coercion, when providing contraception to girls younger than 16 years of age [National Collaborating Centre for Women's and Children's Health, 2005].
• Competence to consent to treatment [FFPRHC, 2004b]:
• Assess a young person's competence to consent to treatment by her ability:
• To understand the information provided and
• To weigh up the risks and benefits and
• To express her own wishes.
• If a young person is determined to be competent, this should be documented in the case notes.
• Documentation [FFPRHC, 2004b]:
• Document assessments made of vulnerabilities, e.g. Fraser criteria.

• The mnemonic UPSIC (UnProtected Sexual InterCourse) can help to remember all these points:
• Understands
• Parents
• Sex/Suffer
• Interests
• Confidentiality; Coercion an issue?

[Guillebaud, 2007]