Contraception for a 16-year-old: Gillick competence

In Australia, a person under 18 can consent to their own medical treatment if they have sufficient maturity and understanding to appreciate the nature, consequences and risks of what is proposed. This is the 'mature minor' or Gillick principle, from the English case Gillick v West Norfolk (1985), adopted by the High Court of Australia in Marion's case (1992). It is a functional test of understanding, not an age. Some states add statutory rules (for example, New South Wales treats consent at 14 and over as valid for the purpose of a doctor's defence, and South Australia has provisions from 16).

The doctor's job is to assess and document that the young person understands what contraception is, how it works, its risks and side effects, the alternatives, the need for condoms against infection, and the importance of follow-up. This girl demonstrates that understanding, is in a consensual relationship with a partner of similar age, and has been screened appropriately.

Once she is judged competent, she is entitled to the same confidentiality as an adult. Her parents are not informed unless she agrees, or unless there is a serious risk of harm to her or someone else, or a mandatory reporting obligation arises, such as evidence of abuse or exploitation. A 17-year-old partner does not raise that concern. The consultation should include a sensitive check for coercion and safety.

Good practice is to encourage her to involve a parent or trusted adult, while making clear that she will be treated whether or not she does. Contraceptive choice should cover long-acting reversible methods (implant or IUD), which are the most effective, as well as the pill, with condoms for infection prevention. The RACGP and Family Planning Alliance Australia support this approach.

Referring a straightforward competence assessment to a specialist is unnecessary and could deter her from seeking care at all.