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Young people and sex: are we thinking about it enough?

Healthcare professionals have an important role in safeguarding children. Here Joanne Fores examines the implications of the Sexual Offences Act for practitioners providing contraceptive and sexual health services for young people

Joanne Fores
RGN ENB 901
Independent Nurse Prescriber
Senior Specialist Nurse
"Choices" Young Peoples Sexual Health Service
Leicester City PCT

Sexual relationships and sexual activity are a normal part of life. Young people develop physically at younger ages than previously and they may show an interest in sex and sexual relationships before the legal age of consent for sexual activity.(1) This interest may include a wish to experiment or take part in sexual activity, including intercourse. Sexual intercourse may be voluntary or may occur as a result of sexual abuse or exploitation, including prostitution, all of which are safeguarding concerns. Concerns regarding underage sexual activity among patients/clients can bring about difficult issues and should be handled sensitively. The sharing of information with other professionals is vital to enable early intervention to ensure that young people are protected from any harm.
Two pieces of potentially conflicting government guidance should be considered in this situation: reassurance for young people that they can seek confidential advice about contraception and sexual health,(2) and recommendations from the Bichard Report about sharing of information relating to actual or potential abusers so that young people are protected.(1)
Young people, often without their parent's or carer's knowledge, may seek contraceptive and sexual health advice and are entitled to the same degree of confidentiality as adults.(3) While the Sexual Offences Act 2003 (SOA) offers stronger protection for children, it has implications that may restrict this confidentiality.(4)

The Sexual Offences Act 2003
The law on sexual offences has been reformed to strengthen measures to protect the public. The SOA 2003 is the first major overhaul of sexual offences legislation for more than a century and was introduced in 2004.(4) Aiming to cover all crimes of a sexual nature, the SOA has updated the existing law as sexual crimes have become more sophisticated. It applies to England and Wales and some sections extend to Northern Ireland and Scotland.
In England and Wales the age of consent for any form of sexual activity (heterosexual or homosexual) is 16 for both males and females. The aim of the SOA is to protect the safety and rights of young people and to make it easier to prosecute those who pressure or force others into having sex or taking part in any sexual activity. It recognises that other children or adolescents abuse children and it should not be assumed that sexual activities between young people are always consensual. The Teenage Pregnancy Unit guidance states that it is not intended that the law be used to prosecute mutually consenting teenage sexual activity between people of a similar age, unless it involves abuse or exploitation.(2)
Although the age of consent remains unchanged, the SOA has introduced new laws to protect those less than 16 years old. Specific sections (part 1, sections 5-8) are applicable to under 13s, and states that sexual activity with such a child is never acceptable even with their consent. The SOA is clear in stating that a child under 13 "does not, under any circumstances, have the legal capacity to consent to any form of sexual activity", and such activity would indicate an arrestable offence.(2)

Implications for practice
If young people are participating in sexual activity, it is important to recognise that they may not fully understand the relationship and the activity within it; peer pressure and perceived norms can be powerful.(1) The younger the participants the more likely that there is cause for concern, eg, local child protection procedures must be followed if a child under 13 has been engaged in sexual activity.(4) It is considered good practice for health professionals to assess any young person under 16 against the Fraser Competence Guidelines (see Box 1).(5)

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For professionals working particularly within the contraception and sexual health arena, there may be conflict between codes of confidentiality, the expectations of the young person, their need for services and child protection guidance. The introduction of the SOA added further tension creating a fear that services and young people's health may be compromised. Due to these concerns, following the introduction of the SOA, the British Medical Association was successful in requesting an amendment (see Box 2), which provides a supportive framework to work within.(6) Therefore the duty of care and confidentiality of health professionals to all young people, including those under 16, has not been compromised by the SOA. This is reassuring as this particular group is the least likely to use contraception, and worries regarding confidentiality could be a deterrent to seeking advice.(9)

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All primary care trusts are responsible for identifying senior leads, both paediatricians and nurses, to undertake the role of designated professional for safeguarding children. This includes ensuring that the needs of children and young people are taken into account in planning and service delivery.(4) It is imperative that training and education reflects the change to practice that the SOA has brought to aid any practitioners who may encounter this type of consultation.
In line with local clinical governance, discussions have taken place with child protection leads regarding clinical decisions and referrals for safeguarding issues. Such support has reduced anxiety among the nursing team. Also, following the publication of guidance from the Local Safeguarding Children Board, our working documents have been modified to gain relevant information relating to the young person's relationship, ie, those under 18 years of age, (see Box 3) and service guidelines amended.(1)

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Conclusion
Due to the high percentage of adolescents attending dedicated sexual health services, issues around safeguarding children need to be at the forefront of any consultation.(4)
The ability of health professionals working with young people to provide confidential advice and treatment is not compromised by the SOA, providing they are not causing or encouraging an offence. Whether a young person is competent to consent to treatment or is in any serious danger is judged on the circumstances of each individual case.
A more up-to-date law is required, which takes into account the changes within the modern family and society, and the long-term damage that sexual violence and abuse can cause. In principle the SOA is designed to protect everyone from abuse and exploitation, and to ensure that regardless of sex, gender or sexual orientation, everyone is equally protected from sexual crime.

References

  1. Local Safeguarding Children Board Leicester. Local Safeguarding Children Board protocol for managing reports of under-age sexual activity. Leicester: LSCB; 2006. Available from: http://www.lscb-llr.org.uk/index/procedures.htm
  2. Department of Health Teenage Pregnancy Unit. Best practice guidance for doctors and other health professionals on the provision of advice and treatment to young people under 16 on contraception, sexual and reproductive health. London: DH; 2004.
  3. NMC. Nursing and midwifery council guidelines for professional practice. London: NMC; 1996.
  4. DH. Working together to safeguard children. Executive summary. A guide to inter-agency working to safeguard and promote the welfare of children. London: DH; 2006.
  5. Gillick v West Norfolk and Wisbech Area Health Authority and another [1986] 1 AC 112. Available from: http://www.hrcr.org/safrica/childrens_rights/Gillick_WestNorfolk.htm
  6. Rogstad KE, King H. Child protection issues and sexual health services in the UK. J Fam Plann Reprod Health 2003;29(4):182-3.
  7. Department for Skills and Education. Enabling young people to access contraceptive and sexual health info and advice: legal and policy framework for social workers, residential social workers, foster carers and other social practitioners. Nottingham: Crown Copyright; 2004.
  8. Department for Skills and Education. Enabling young people to access contraceptive and sexual health advice. Guidance for youth support workers. Nottingham. Crown Copyright; 2005.
  9. Hughes L. Developing primary care services for young people. Br J Fam Plann 2000;26(3):155-60.

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