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Coercive Control — DFSRH MCQ

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HardCoercive ControlDFSRH

A 30-year-old woman attends an integrated sexual health service in England requesting an etonogestrel implant. Pregnancy is reasonably excluded, there is no medical contraindication and, after counselling while alone, she makes a capacitous and voluntary choice. She reports that her partner repeatedly disposes of her contraceptive pills, demands that she become pregnant and checks her phone after healthcare appointments. He coerced her into granting proxy access to her GP online services and examines new record entries. Correspondence from this service is routinely transferred to the GP record. She fears that visible documentation, an unexplained hidden consultation or sudden loss of proxy access may provoke him. She has no dependent children or care-and-support needs. Structured assessment identifies no violence, threats, stalking, strangulation, weapons, escalation or other indicator of imminent or high risk of serious harm. She declines police involvement and specialist domestic-abuse referral but accepts safety planning. Which is the most appropriate management plan?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Insert the implant; record the disclosure with restricted online visibility, agree safe communication, and plan proxy-access changes with safeguarding and information-governance leads.

Explanation lettering: D = shown as A · E = shown as B · B = shown as D · A = shown as E

Disposal of contraception and pressure to become pregnant constitute reproductive coercion within domestic abuse. However, coercion within the relationship does not negate this patient’s independently assessed capacity or voluntary choice of implant. Deferring contraception until she accepts support would further impair her reproductive autonomy. The disclosure should be recorded accurately: NHS proxy-access standards state that access concerns must not inhibit safeguarding documentation. The record and associated correspondence should be restricted from online visibility where disclosure could cause harm. Nevertheless, redaction or abrupt proxy-access withdrawal can itself reveal, by inference, that sensitive information exists. Changes therefore require a case-specific plan agreed with the patient and informed by safeguarding and information-governance expertise. A incorrectly makes safeguarding review and acceptance of referral prerequisites for clinically appropriate contraception. B may appear digitally safer, but omission compromises continuity and future risk assessment, while unrestricted correspondence may reveal the consultation. C correctly recognises unsafe proxy access but uses a notification process that could alert the perpetrator and precipitate harm. D overinterprets the criminal status of coercive control: criminality does not itself impose automatic police reporting, and MARAC is intended for high-risk domestic-abuse cases. Information sharing without consent must have a lawful, necessary and proportionate risk-based justification. None is established here, although risk must be reviewed and escalation reconsidered if circumstances change.

Reference: Domestic Abuse: statutory guidance (accessible version) (13 April 2023) — https://www.gov.uk/government/publications/domestic-abuse-act-2021/domestic-abuse-statutory-guidance-accessible-version Safeguarding (26 March 2025) — https://www.england.nhs.uk/long-read/safeguarding/ DAPB3051: 4.1.3 Establish whether access is safe (6 May 2026) — https://digital.nhs.uk/services/national-proxy-service/dapb3051-authorisation-use-case-proxy/4.1.3-establish-whether-access-is-safe