A 26-year-old woman with a moderate learning disability attends an SRH clinic with her mother, who requests an etonogestrel implant because pregnancy

Question

A 26-year-old woman with a moderate learning disability attends an SRH clinic with her mother, who requests an etonogestrel implant because pregnancy would be difficult for the family to manage. The woman lives in supported accommodation and communicates using short phrases and Makaton. Her mother has no health and welfare lasting power of attorney. No accessible contraceptive counselling or decision-specific capacity assessment has occurred. During the consultation, the woman becomes quiet when her mother answers for her. Her mother reports that a male resident has twice been found in the woman's bedroom and that staff recently noticed unexplained bruising on her inner thighs. A urine pregnancy test is negative and there is no known recent unprotected intercourse or acute injury. What is the most appropriate immediate management?

Accepted Answer

See the woman separately with communication support, assess capacity specifically for contraception, raise an adult safeguarding concern now and defer insertion pending valid authorisation

Answer

Insert the implant with the mother's written agreement, document presumed best interests and make a routine safeguarding referral afterwards

Answer

Apply immediately to the Court of Protection for authority to provide contraception before undertaking either capacity assessment or safeguarding referral

Answer

Administer depot medroxyprogesterone acetate as a temporary best-inter interests measure, then arrange formal capacity and safeguarding assessments

Answer

Prescribe oral emergency contraception and a progestogen-only pill, then ask the supported-living provider to investigate before considering a safeguarding referral

Vulnerable Groups — DFSRH MCQ