Makindo Medical Notes

⚠️ When applying Fraser guidelines for contraception or sexual health in those <16, always consider child protection concerns.

📖 Introduction

• ✔️ Fraser guidelines apply when giving advice or treatment about contraception and sexual health to individuals under 16.
• They can be used by doctors, nurse practitioners, and other healthcare professionals.
• 📌 They also extend to treatment of STIs and pregnancy termination (Axton v Secretary of State for Health, 2006).

🧠 Consent & Gillick Competence

• Children <16 can consent to medical treatment if they show sufficient maturity and understanding.
• This was established in Gillick vs West Norfolk & Wisbech AHA (1985) → the concept of Gillick competence.
• 👉 In practice, clinicians must judge if the young person fully understands the treatment, risks, and alternatives.

✅ Fraser Guidelines Criteria

The healthcare practitioner must be satisfied that:

• 🙅 The young person cannot be persuaded to involve parents/carers, nor allow the professional to do so.
• 🧩 They understand the advice being provided.
• ⚕️ Without treatment/advice, their physical or mental health would likely suffer.
• 💡 It is in their best interests to receive treatment without parental consent.
• ❤️ They are very likely to continue sexual activity, with or without contraception.

🛡️ Child Protection Considerations

• 🔍 Always screen for safeguarding risks when applying Fraser guidelines.
• ⚠️ Under-13 sexual activity = automatic child protection referral.
• 🔄 Repeated STIs or terminations may indicate sexual abuse or exploitation.
• 🚨 Children who are groomed may not recognise they are being abused.
• 📑 Review previous concerns, and explore family/social context for hidden risks.
• 🤝 Share safeguarding concerns with social services/police, even if the child asks for confidentiality.

📚 References

• NSPCC: Gillick Competence & Fraser Guidelines
• NICE Guideline NG7: Contraceptive Services for Under 25s

Clinical cases

• 👧 Case 1 – Fraser Guidelines (Age 15): Teenage girl attended GP requesting contraception without parental knowledge. She was in a stable relationship and appeared mature. Assessment: GP applied Fraser guidelines — she understood the advice, could not be persuaded to inform parents, was likely to continue sexual activity, and her physical/mental health might suffer without contraception. Management: Contraceptive pill prescribed with counselling on sexual health and confidentiality. Teaching point: Fraser guidelines allow provision of contraceptive advice or treatment to under-16s if the professional judges it in the young person’s best interest and they meet all five criteria.
• 🧠 Case 2 – Gillick Competence (Age 14): Girl with type 1 diabetes refused insulin dose adjustment despite her parents’ disagreement. She demonstrated clear understanding of risks, benefits, and long-term consequences. Assessment: Considered Gillick competent — possessing sufficient intelligence and maturity to make her own medical decision. Management: Her autonomy was respected; diabetes nurse specialist provided tailored education and close follow-up. Teaching point: Gillick competence applies broadly to under-16s — a child who fully understands the nature and consequences of a treatment decision may consent (or in some cases, refuse) independently.