Garth Rattray

Everyone, especially healthcare workers, educators and health administrators, has a moral and legal duty to report child abuse cases. This obviously encompassed sexual abuse but, several of my colleagues never realised that this included reporting pregnant minors.

The Child Care And Protection Act (2004), Part 1, section 6 (Duty to report need forcare and protection), clearly states that: "Any person who has information which causes that person to suspect that a child - has been, is being or is likely to be, abandoned, neglected or, physically or sexually ill-treated; or is otherwise in need of care and protection shall make a report to the Registry." No one knows of any such entity; instead, the authorities pointed me to the Centre for Investigation of Sexual Offences and Child Abuse (CISOCA) - a police unit.

Under section 6, the persons held especially accountable to report child abuse are physicians, nurses, dentists or other health or mental health professionals. It also extends to hospital administrators, school principals, teachers, other teaching professionals, social workers, guidance councillors and operators and employees of day care centres, among others. Should a 'prescribed person' (as stipulated above) fail to make a report, he/she will be guilty of committing an offence and 'liable upon summary conviction before a resident magistrate to a fine not exceeding $500,000 or imprisonment to a term not exceeding six months or to both such a fine and imprisonment'.

Jamaican law allows medical professionals to give advice on contraception to minors in confidence. Yet, notwithstanding our ethical obligation to uphold that confidentiality, the Child Care and Protection Act 2004, implementation handbook for professionals protects us from litigation by specifying that sexually transmitted infections, pregnancy and sexual violence require full disclosure.

Consenting to sexual intercourse

Even precocious and worldly-wise teenage girls are, by law, considered incapable of consenting to sexual intercourse until they become 16 years old. So, technically, all pregnant minors are victims of carnal abuse. Currently, only the male is held accountable (and may be arrested) for the illegal act even if he is a minor himself. Because underage girls should never engage in any activity that could make them pregnant for anyone of any age, 'prescribed persons' are mandated to report the pregnancy (because it's blatant evidence of carnal abuse).

The rationale behind the law is well researched, in-depth and very sound. It covers just about everything except the possible deleterious ramifications of forcing medical personnel to report teenage pregnancies. It is therefore a great pity that the powers-that-be never saw the wisdom of seeking our opinion on this significant matter. As far as I know, it was never put before the various medical associations for open debate and discussion by their members.

Judicious laws are made by wise and informed individuals, however, in reality, things aren't always so straightforward. For instance, the government-run Victoria Jubilee Hospital has maintained its Thursday Antenatal Clinic for the care of pregnant teenagers the medical staff is struggling with the ethicality of reporting their patients to the police CISOCA. They also fear driving the pregnant minors underground. Then there's the possibility of personal endangerment from vindictive babyfathers. Fortunately for them, there's a hospital social worker who intervenes in order to comply with the 2004 Act. Private practitioners however have no such facility.

For the sake of our teenagers, health workers and the doctor-patient relationship, this extremely important topic (the reporting of underage pregnancies by doctors) deserves further (in-depth) discussion.

Next week: Pitfalls of reporting teen pregnancies.