Confidential contraception request from a 16-year-old
A 16-year-old girl attends alone after school and asks for the contraceptive pill. She has been with her 17-year-old boyfriend for six months and they are not using contraception. She is in fifth year, doing well at school, and has no mental health concerns or chronic illness. She says the relationship is consensual and not coercive, and she does not want her mother to know. On assessment she shows a clear understanding of the risks, benefits, and alternatives, and can explain what she would do if she missed a pill. In Ireland the age of consent is 17. She is not currently in crisis and has no symptoms of STI. She asks that nothing be written to her mother.
1. How would you approach confidentiality and competence in this consultation?
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Explain at the start that the consultation is confidential, but that confidentiality has limits if she or someone else is at risk of serious harm. This is not a reason to refuse care; it is transparency. Assess Gillick competence: does she understand the risks and benefits of contraception, the alternatives, the consequences of unprotected sex, and can she weigh them and communicate a consistent view? She appears competent on your assessment.
Encourage but do not require parental involvement. Explore the relationship: whether it is consensual, whether there is pressure, the age gap, and whether she feels safe. Ask about STI risk and previous sexual activity. Offer condoms and STI screening. Explain that she can change her mind at any point and that you will see her again. Record the competence assessment, the discussion about confidentiality and its limits, and her wishes in the notes, which are her confidential record.
2. What are your child protection obligations, and would you prescribe?
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In Ireland the age of consent is 17, so she is legally a child. As a mandated person under the Children First Act 2015, you must report reasonable grounds for believing a child is being harmed or is at risk of harm. Consensual sexual activity with a peer of similar age does not automatically meet that threshold, but you must consider coercion, power imbalance, a significantly older partner, exploitation, or evidence of harm. If you have concerns, discuss with the practice's designated liaison person and report to Tusla. If there are no concerns, document your reasoning.
If she is competent and acting voluntarily, prescribing contraception is not unlawful and is in her best interests to prevent pregnancy and support safer sex. It is reasonable to prescribe a progestogen-only or combined method after checking blood pressure and history. Offer condoms, STI testing and information about emergency contraception. Do not promise absolute confidentiality if a safeguarding concern arises; explain what you would need to share and why.
3. How would you document the consultation and what follow-up would you arrange?
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Record that she attended alone, her competence assessment, the discussion of confidentiality and its limits, the child protection consideration and its outcome, the options discussed, and the method chosen with the reasons. Note that parental involvement was encouraged but declined. Keep the record factual and avoid judgmental language, because she or her family may later read it.
Arrange review in three months to check blood pressure, side effects, adherence and satisfaction. Offer STI screening now and at any change of partner, and discuss condom use. Give clear advice about missed pills and emergency contraception, including where to get it. Explain that cervical screening starts at 25. Encourage her to consider talking to her mother, and offer to support that conversation. Provide a phone number for questions and ensure she knows she can return at any time.