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Abstract
The decision to provide under-18s with contraception is potentially challenging due to numerous factors that may influence such a situation. Anecdotal indications suggest that relevant legal guidelines, Fraser Guidelines and Gillick Competence, are confused. Furthermore, these guidelines originated when societal attitudes to sexual behaviour differed vastly from today which may affect their applicability nowadays.
Objective To explore clinicians’ understanding and implementation of relevant guidelines regarding contraception for females under-18; namely Gillick Competence and Fraser Guidelines.
Design Semi-structured interviews with twenty North London clinicians providing contraception to young people within General Practice or Sexual and Reproductive Health. Transcripts were analysed via structured implicit abstraction and emergent themes noted.
Results Three-quarters of clinicians found these consultations challenging and all clinicians utilised the Fraser Guidelines to some extent, however, three-quarters of clinicians demonstrated some confusion in their understanding. There was evidence of confusion between the terminology or content of Fraser Guidelines and Gillick Competence amongst three-quarters of clinicians.
Implementation of each criteria of the Fraser Guidelines varied and specific criteria were overlooked when in conflict with a clinicians’ personal opinion. Certain recurring themes commonly influenced the implementation of the Fraser Guidelines including:
emphasis on patient confidentiality,
method of contraception,
adequate safeguarding and child protection dependent upon the patient’s age,
informing adults who are not a young persons’ parents and,
prevention of pregnancy as an absolute priority.
Conclusion Evidence of confusion between Fraser Guidelines and Gillick Competence can be disseminated and clinicians’ understanding improved via explanation of content and clarification of differences.
More significantly, implementation of guidelines appears to be largely dependent upon clinicians’ personal views and not solely their understanding. These views seem to be shaped by both changing societal attitudes to sexual behaviour and personal priorities of the individual.
The findings encourage further debate as to why implementation of the guidelines vary and to identify key factors that influence clinicians’ views and henceforth their clinical practice. The relevance of these guidelines in current practice must be considered as well as how to reconcile situations when clinicians’ experiences conflict with legal guidelines.