Provision of Contraception and Contraceptive Advice to Children in Care

Young people who are Looked After are likely to engage in sexual relationships at some point in their lives, and this policy is not about preventing that (which is probably an unattainable goal), but rather about ensuring that they are given the opportunity to be protected from exploitation, unwanted pregnancy and sexually transmitted infections (STI's).

In order to protect them from unwanted pregnancy there is a range of contraceptives and some especially suitable for young people. To give them some protection from STI's they will need to use condoms (either the traditional condom or the Femidom) every time that intercourse takes place.

Evidence has shown that sexually active people who regularly change their partners and have unprotected intercourse with others who are doing the same are at a much higher risk of sexually transmitted infections than any other group. If young people Looked After are engaging in this form of practice them condom use is imperative to avoid such infection. Condoms can be used dually with another form of contraception, such as the pill or hormone injection. This practice is often called "double dutch". Young people who habitually have unprotected sex and who will not use condoms should be encouraged to have regular screenings for STI's which can be obtained from local GUM clinics. The long-term effects of not being treated for STI's can be extremely serious, such as infertility and early death.

Care needs to be taken to protect young people from abusive relationships. Talking about contraception and their sexual relationships may be one way of encouraging them to talk about and disclose any such relationship. 

All young people 16 years of age and over should be given information regarding contraception, where to obtain contraceptives, and on request obtain condoms from any member of staff/foster carer closely involved in their care, bearing in mind the house rules, their intellectual and physical capabilities and the information contained in London Safeguarding Children Procedures, Sexually Active Children Procedure.

For the 16 year old not yet having sexual relationships, they must be given appropriate opportunity to discuss sexuality/relationship issues as they arise. It is important that they are given information about access to sexual health and contraceptive services before they become sexually active. They should be encouraged to consider whether being sexually active is their own decision. They should be given the information in a factual manner that also highlights the issues around ST1's, teenage pregnancy and keeping safe.

For the 16 year old already engaging in sexual relationships, open discussion should be encouraged with a close confidant. It is hoped that the young person at this age could be independent in accessing contraceptives/contraceptive advice. If not, their Link Worker, foster carer or other appropriate person should work with the young person to facilitate their eventual independence.

The law is clear that sexual intercourse under 16 is an offence. However, some young people under the age of 16 will have sexual intercourse and may not stop even if it is thought inappropriate by adults. If there is no way this can be prevented then it is ethically reasonable to prevent the child from facing further harm by encouraging the use of contraceptive where appropriate.

Any children in these situations need to be reminded of the legal situation, and should be treated with sensitivity bearing in mind the possible child protection issues.

For the 13/14/15 year old not yet having a sexual relationship, staff/foster carers should encourage rapport on sexuality/relationship issues, as well as providing appropriate information in relation to contraception and diversionary activities.

For the 13/14/15 year old already having sexual relationships, they should be introduced to contraceptive/sexual health services, and encouraged and supported to attend for advice and treatment as necessary. Staff/foster carers should consider whether the relationship is abusive or coercive, whether the age or developmental difference between the couple is so large that it is considered that the partner is too powerful. In appropriate cases, a referral to the child's social worker should be made - see Safeguarding Sexually Active Children.

Young people of these ages should be encouraged into other, more positive diversionary activities.

It is often said that ambition is the greatest form of contraception, and young people should be encouraged with school-work, hobbies and other community based activities that build self-esteem and self-worth.

There is understandably some concern about the legality of providing contraceptive advice to under 16's. There are however, guidelines used by the medical profession in the light of the Gillick case. These are known as the Fraser Guidelines and have been adopted by professionals in the social care economy as guidelines of good practice. These guidelines suggest that contraception may be issues to under 16's if:

The young person could understand the doctor's advice (*) and had sufficient maturity to understand what was involved in terms of the moral, social and emotional implications;

• The doctor (*) could not persuade the young person to inform the parents, her allow the doctor (*) to inform them, that contraceptive advice was being sought;
• The young person would be likely to begin or continue having sexual intercourse with or without contraception;
• Without contraceptive advice or treatment, the young person's physical or mental health, or both, would be likely to suffer;
• The young person's best interests require the doctor (*) to give contraceptive advice, treatment, or both, without parental consent.

_{* The word "doctor" for the purpose of this paper, can be transposed by "nurse" or "other appropriate professional".}

It must be noted that young people can access their own advice from contraceptive services without adult consent. If a young person requests information on contraceptive services, they should be given it, and this can be kept confidential, unless there are issues surrounding the age of the young person or the abusive nature of the relationship, when it must be raised with a residential manager and the child's social worker as a cause for concern - see Safeguarding Sexually Active Children.

Where appropriate, staff should, in the first instance always support the young person to seek personal contraceptive advice from the Family Planning Service, GP, LAC Health Visitor or other health resource. 

If a young person finds it difficult to do this, then staff in residential care may provide them with condoms until such time as the young person is able to access advice and help for themselves (with support if necessary).

It must be borne in mind, that unless condoms are used properly, they are not a reliable form of protection/contraception. Young people, because of their life experiences, sometimes lead chaotic lives. Sometimes young people's use of condoms can also be chaotic and so for this reason, other forms of protection/contraception will need to be encouraged and/or discussed.

If a young person is thought to need condoms, the best way forward needs to be established. Some young people may prefer to work with their Link Worker, or another member of staff in the home. Others may prefer to work with another professional, such as the LAC Health Visitor, or the Phoenix Project. Condoms should not be left in the bathroom or toilet.

On the first occasion that condoms are requested, a member of staff should confirm with the young person that they know how to use a condom, giving a single explanation using the instructions from a packet of condoms. Staff should consider encouraging the young person to meet with the Phoenix Project, or agree for a referral to the LAC health Visitor so that a more detailed demonstration of condom use, using an approved condom demonstrator and to discuss further issues about contraception, STI's etc.

All residential care staff can issue condoms to young people aged 16 and over. 

Young people in residential care who are under 16 can be issued with condoms, provided that this decision is supported by the Unit Manager, who may need further advice from the LAC Health Visitor.

Anal intercourse is legal in this country if both partners consent. It is a sexual activity that both males and females engage in. If it is felt that the young person requesting condoms wants them for anal intercourse, then they should still be supplied as unprotected anal intercourse is regarded as the highest risk with regard to contracting HIV. They should also be advised to use extra strong condoms and to use plenty of water based lubricant. Extra strong condoms can also be supplied free from GUM clinics.

Sex between consenting men over the age of 18 can be a healthy and fulfilling lifestyle. If either party is under 16, as the law currently stands, both males are committing an offence. There is no similar law for lesbian relationships. Young gay men under 18 should still be supplied with condoms, but also advised to obtain the extra strong condoms and use water based lubricants.

Young people who are lesbian, gay and bi-sexual and those who are unsure of their sexual preference may need more support to deal with society's homophobia. Professionals working with these young people are encouraged to obtain information about local supportive networks.

Pregnancy tests should be accessed via the GP or Family Planning Services. In this way the appropriate health professionals can deal with potential health advice regarding pregnancy. 

It is not recommended that staff/foster carers purchase home testing kits as they are not 100% accurate.

This should be accessed via the GP, Family Planning Service and GUM clinic. If this is difficult (e.g. at the week-end) then they are available at the A&E Department, Hillingdon Hospital, and some chemists. The appropriate follow up for sexual health needs and contraception should be arranged as soon as possible. The NHS help line can offer advice-information with regard to emergency contraception.