Agency, Structure and Abused Consent in relation to young people’s decision making

I have for some time been using Jenny Pearce’s very useful model (A Social Model of abused consent, Pearce 2013) to help health professionals to consider the influences their decision-making and professional curiosity when working with young people.




Agency can be described as the capacity of individuals to act independently and to make free choices but Structure is the societal patterns, which restrain individual choice. Consent is where a person agrees by choice, and in health the focus on this choice has been the mental capacity to make that choice. In young people the guiding principles have been Frazer Guidelines (or Gillick Competency). However these have been developed around access to services rather than “ lifestyle choices”.


For Health practitioners assessing young people who could be victims of sexual exploitation the influence of Structure can be significant in deciding if the young person has agency and if you have a responsibility to safeguard the young person. Critically the model also focuses on the role that the Health Professional can play in the Structure surrounding the young person’s capacity.


Coerced Abused Consent is the area most focuses on by CSE research where the young person is groomed and believes themselves to Agency to consent but the Structure of grooming by their abuser means they do not have the developed capacity to sexual activity. They will often side with their abuser and not recognise the power differential. This is why victims often recognise the abuse that occurred to them when they are exploited as 13/14 year olds only when they reach further maturity at 17/18years.


Survival Abused Consent fits with Maslow’s Hierarchy of needs where the young person believes that their own or their family/friends survival depends on them engaging in sex acts for money, food, drugs, or accommodation. It is important that safeguarding a young person in this situation attends to these needs and not just their victim status.


Abused Normalised Consent is where the young people themselves normalize the engagement in violent non-consenting sex. The focus of this can be on access to pornography, sexting, music lyrics but also expectations in gang culture, peer pressure and normalizing the violence by peer group perpetrators. There can be focus on young people who groom other young people and this can be seen as a way of getting out of being assaulted themselves; but it is also a way of normalizing their own experiences and the wish to be normal is a very powerful structural issue.


Professional Condoned Abused Consent is potentially the post important for health professionals. I agree with Jenny’s view that this can be both conscious and unconscious but with a slightly different emphasis. The unconscious may be due to personal experience (Both lack of knowledge of CSE but also our abusive experience that we bring to the work- we all want to normal!), but also driven by a culture in which the focus or target of our core task is preventing our thinking about CSE (e.g. a target to reduce teenage pregnancy and increase use of contraception could unconsciously lead to us not asking “awkward questions) But this may also be a conscious decision to avoid the subject. “They know what they are getting in to” “ all 14 year olds in that area (Usually referring to a poorer area of the city or a run down town) are having sex” This normalization of their abuse reinforces the young person’s experience that their exploitation is accepted and that they are an “other” to the professionals. This is the most dangerous professional position and one I have seen all to often in the Health Community.


In summary Health Professionals have a vital role in protecting young people from sexual exploitation and must attend to the issues beyond the inherent developmental capacity to considering the influences Abused Consent that influence a young person’s Agency.


Jenny Pearce’s original paper is in “Critical perspectives on Child Sexual Exploitation and Related Trafficking” Melrose & Pearce, Palgrave-Macmillan 2913


Ray McMorrow – NWG -19th November 2014