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Fraser Competence — DFSRH MCQ

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EasyFraser CompetenceDFSRH

A 15-year-old girl with a mild learning disability attends an English community sexual health clinic alone and requests a desogestrel progestogen-only pill. She wishes to avoid pregnancy, says that she will continue having consensual intercourse with her 15-year-old partner, and cannot be persuaded to involve a parent or carer. There are no indicators of coercion, exploitation or other safeguarding concerns. The clinician uses easy-read material, short explanations and teach-back. Despite this, she repeatedly states that the pill is needed only on days when intercourse occurs and that it prevents chlamydia. She cannot explain the implications of missed pills or compare the roles of the pill and condoms. She can clearly communicate that she wants the pill and does not want her family informed. Which is the most appropriate management?

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

Reveal the answer and explanation

Correct answer: C — Do not prescribe today; maintain confidentiality, offer further supported counselling and reassess her competence

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

Fraser competence requires more than expressing a stable preference. For contraceptive treatment without parental consent, an under-16 must understand the advice and be able to use and weigh information about the proposed treatment. Despite appropriately adapted communication, this patient cannot distinguish contraception from STI prevention or understand how the pill must be used. She therefore cannot currently provide valid consent to the requested prescription. Her diagnosis alone does not determine competence, so further supported counselling and decision-specific reassessment are appropriate. Failure to demonstrate competence does not itself justify breaching confidentiality. In the absence of a serious safeguarding concern, her attendance and disclosures should remain confidential, while involvement of a parent, carer or another trusted adult continues to be encouraged. B is incorrect because communicating a preference does not compensate for inability to understand and weigh material information. C incorrectly treats lack of Fraser competence as authority to disclose confidential information. D is inappropriate because disclosure to the GP requires consent unless there is another justification for information sharing. E is incorrect because competence is assessed individually and may develop or be demonstrated with appropriate communication support; it is not postponed automatically until age 16.

Reference: FSRH Clinical Guidance: Contraceptive Choices for Young People (March 2010, amended April 2026) — https://www.fsrh.org/Common/Uploaded%20files/documents/fsrh-guideline-contraception-young-people-may-2019.pdf FSRH Clinical Guidance: Contraceptive Choices for Young People (March 2010, amended April 2026) — https://www.fsrh.org/Common/Uploaded%20files/documents/fsrh-guideline-contraception-young-people-may-2019.pdf If I use a sexual health service will they tell my parents? (Reviewed 13 August 2026) — https://www.nhs.uk/live-well/sexual-health/confidentiality-at-sexual-health-services/