Fraser competence — DRCOG MCQ

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HardContraception and Sexual HealthFraser competenceDRCOG

A 16-year-old attends alone requesting contraception. She understands the method, risks and alternatives, does not want her parents informed and denies coercion. She has a 17-year-old partner. What is the most appropriate management?

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Correct answer: A — Assess Fraser competence and provide confidential contraception if competent

The best answer is “Assess Fraser competence and provide confidential contraception if competent”. A young person under 16 can receive confidential contraceptive care if Fraser competent, after safeguarding assessment. Informing parents without consent is not automatic and may deter care. The pearl is that confidentiality and safeguarding must be considered together, not treated as opposites. UK contraceptive decisions use UKMEC 2025, not US MEC, and require method-specific rather than class-wide reasoning. Oestrogen-related stroke and thrombosis risks may rule out CHC while leaving progestogen-only or intrauterine methods available. Emergency contraception and quick-start decisions additionally require precise timing and follow-up pregnancy testing.

Reference: CoSRH, UK Medical Eligibility Criteria for Contraceptive Use 2025: https://www.cosrh.org/Common/Uploaded%20files/documents/UKMEC_2025.pdf