The revelation that girls as young as 14 can have an abortion
without their parents’ knowledge has come as a shock to many.
Don’t schools have to tell parents if they know a girl is
pregnant? Don’t the parents have any right to know what is
going on? What if something went wrong with the abortion procedure?
A whole host of questions have been asked in the wake of the
Michelle Smith case, but those who work with young people know just
how essential it is that confidentiality is maintained.
Since 1986, doctors and other health workers have been working
according to the Fraser guidelines, formulated after the case in
which Victoria Gillick unsuccessfully challenged the legality of
girls under 16 getting contraceptive advice without their
parents’ knowledge. Under these guidelines confidential
advice and treatment can be given to young people provided certain
conditions are met.
Part of the recent confusion has stemmed from a lack of
knowledge about the situations in which workers can give
confidential advice to young people. While schools will have their
own confidentiality policies, these do not cover health
professionals working on their premises. Teachers may not be able
to guarantee confidentiality to a pupil, but health professionals
must, just as they would if they worked in a hospital or
doctor’s surgery. And this is essential if young people are
to be encouraged to seek help.
“Young people need access to confidential advice. They have made
it clear that they won’t seek advice if they think someone is
going to talk to someone else,” says Anne Weyman, chief executive
of the Family Planning Association.
She says that young people often delay talking to anybody for
fear that professionals will tell their parents. But with
pregnancy, whatever the girl decides, early support is vital.
There will be extraordinary circumstances where a health worker
will break confidentiality. This may happen if they consider that
the young person is incapable of making a decision for themselves,
or where the young person or another child is in danger.
Nonetheless, while health workers will not threaten to tell
others, they will encourage young people to speak to their parents,
provided it is in their best interests. But for some young women,
telling their parents will be the worst thing they can do.
“There are families where if they discovered their daughter was
having sex they might attack or kill her because of the shame on
the family,” says Phillip Hodson, speaking on behalf of the
counselling in education division of the British Association for
Counselling and Psychotherapy, which includes teachers and nurses
with counselling training.
Even in less extreme cases, there may be good reasons why a girl
would prefer not to tell her parents. It might be that she does not
get on with them, or she may worry that her parents will pressurise
her into a course of action against her wishes.
However, consulting the right professionals can help a young
person to reach the right decision.
“Instead of seeing a worker who is mainly concerned to find a
solution they need to see a professional counsellor who is
concerned to give and bring insight into the situation. It takes
five years to train as a counsellor,” says Hodson.
In order for young people to know what help is available,
services need to be brought to their attention. And it’s down
to those services, NHS or otherwise, to not only advertise their
wares but to make it clear that confidentiality will be
“Traditionally you don’t get advertisements for GUM
(genito-urinary medicine) clinics but young people need to know
where there are places they can go to get help. There’s no
point them saying ‘There’s a sexual health clinic
around the corner but I still won’t go because they might
tell someone’,” says Anna Martinez, co-ordinator of the Sex
One way to make seeking sexual health services more attractive
is to make them available at school.
“If you look at the evidence, you find that there are lower
teenage pregnancy rates and better sexual health in general in
countries where sex education is linked to health services, such as
where schools have health services on site or where a health
visitor visits a class,” says Martinez. And making sure services
are welcoming to young people, and are open around school hours can
make all the difference.
What seems clear is that any moves to weaken the rules around
confidentiality would lead to more children and young people