In terms of perceptions, attitudes and practices related to sexuality and reproductive health, the  Young Adult Fertility and Sexuality (YAFS) Study in the Philippines, for instance, noted that the  level of a female’s education is a factor in health awareness, age of first sexual encounter and first  45 pregnancy, among others. The difference in the responses coming from different geographical  location (i.e., regions) were also noted in the study, for instance, more survey respondents from the  National Capital Region indicated access to various forms of media for information (digital media, in  46 partcular) compared to those from the Autonomous Region of Muslim Mindanao (ARMM).   Cultural nuances may also be factors in findings with regard to sexual initiation, for example, more  youths from NCR (41%) and Central Luzon (39%) have engaged premarital sexual activity, while  ARMM, where early marriage is common, posted the lowest number of responses at 6.7 percent.  With regard to marital status more NCR youths (20%) are or have been in “live-in” relationships  compared to ARMM (1%).     While reproductive health is clearly an issue concerning the care of the physical body of women,  their ensuring mental health is equally important – and it is here that there is very limited  information, if one is to go by published statistics. The World Health Organization (2009) noted that  women are at greater risk for mental health issues because of the socio-cultural and political factors  47 that reinforce, even institutionalizes, gender-based discrimination and violence against women.   Particular to the interface of reproductive and mental health --     Mental health problems may develop as a consequence of reproductive health problems or events.  These include lack of choice in reproductive decisions, unintended pregnancy, unsafe abortion, sexually  transmissible infections including HIV, infertility and pregnancy complications such as miscarriage,  stillbirth, premature birth or fistula. Mental health is closely interwoven with physical health. It is  generally worse when physical health including nutritional status is poor. Depression after childbirth is  45 Some of the key findings in this regard are the following (quoted from Demographic Research and Development  Foundation (DRDF) and University of the Philippines Population Institute (UPPI) (2014). ​2013 YAFS4 Key Findings.​   Quezon City: DRDF and UPPI.):  ● The proportion who had their sexual initiation before age 18 is highest among those with elementary schooling  (30%) and decreases as education increases   ● The median age at sexual initiation is 1 year later among those with college education (18.4 years) compared  with youth who had elementary schooling (17.4 years) or were high school undergraduates (17.3 years).   ● Among the youth who have ever been in a marital union in 2013, there is a larger proportion living- in than  formally married. This general pattern is more pronounced among the younger (7% vs. 2%) than the older  cohort (24% vs. 18%), among males (8% vs.4%) than females (20% vs. 13%), among those with lower  education (13% vs. 7%) than those with higher education (15% vs. 10%). NCR (20%) and Eastern Visayas  (19%) are the top two regions with the largest proportion of youth in a live-in arrangement while ARMM (1%)  and SOCCSKSARGEN (7%) have the lowest.   ● Teenage childbearing is highest among those with elementary education (26%) and high school graduates  (23%). It is lowest among the college educated (7%).   ● Among the females aged 15-24 who had begun childbearing, the median age at first birth is 19.3 years. This  increases with increasing educational attainment - from 18.0 years among women who did not reach high  school to 20.1 years among those who have reached college   46 The tracking the use of the internet among the youths show the wide disparity of access among regions. On the  opposite extremes are the NCR wherein 92.3 percent of the respondents said they use the internet, and the ARMM  where only 22.4 youths have access to it. (Ibid.)  47 World Health Organization (2009). ​Mental health aspects of women’s reproductive health : a global review of the literature.​   Retrieved from ​http://apps.who.int/iris/bitstream/10665/43846/1/9789241563567_eng.pdf   14 RH Situationer: Phlippines (November 2017)