Marlene Makenzius

About me

I earned my PhD in medical sciences from Uppsala University in 2012. Professionally, I am a registered Nurse Midwife (1997), District Nurse (1999), and hold master's degrees in Public Health Sciences (2008) and a master's degree in Quality Management and Leadership (2009). I undertook post-doctoral positions at Karolinska Institutet and the University of Nairobi between 2014-2018. Additionally, I served as a senior analyst at the Public Health Agency, Sweden, from 2007 to 2020.

Background

Midwife
Community Nurse (Dsk), MIUN
Master in Public Health, MIUN
Master in Quality and Leadership, MIUN
PhD Reproductive Medici and gynaecology, Dept. Women's and Children's Health, Uppsala university
Post doctor, Dept. Global Public Health, Karolinska institutet

Area of interest

- Sexual and Reproductive Health and Rights (SRHR)
- Abortion, Unsafe abortion, Male involvement, Social stigma
- Domestic violence
- Global Health
- Public Health Policy
- RCT, Intervention studies, pre- and post test design, Interviews and Focus Group Discussions

Research

Initially, my research delved into the sexual and reproductive health of adolescents, especially male adolescents, and youth-friendly clinics in Sweden. My doctoral research (2009-2012) centered on the experiences and needs of women and men concerning induced abortion in Sweden, particularly views on preventing unintended pregnancies. This study encompassed 798 women and 600 of their partners, sourced from 13 clinics using both quantitative and qualitative methods. It highlighted both individual and societal challenges: notably, women (and their partner) undergoing repeated abortions often faced greater disadvantages, suggesting the importance of ongoing abortion care evaluation for satisfaction, safety, and contraceptive adherence.

Between 2014 and 2022, my post-doctoral research in Kisumu, Kenya, covered the treatment of complications from unsafe abortions, contraceptive usage, and the associated stigma. In collaboration with the Kisumu Medical and Education Trust (KMET) and the Ministry of Health (MoH) in Kisumu County, a Randomized Controlled Trial (RCT) conducted from 2013 to 2016 assessed the effectiveness of midwives administering Misoprostol for women with incomplete abortions compared to physicians (financed by VR). The results indicated the effectiveness, safety, and acceptability of midwives using Misoprostol was comparable to physicians. Furthermore, while many PAC-seeking women were motivated to use contraceptives, many young women declined them. By April 2020, Misoprostol became the primary treatment for first-trimester abortions at the study hospitals, signaling a lasting policy change.

Social stigma surrounding abortion and contraception in Kenya is significant, pushing many women, especially the young and unmarried, to conceal pregnancies. This secrecy poses risks, as many avoid learning about contraceptives due to stigma. A major issue in Kenya is the inadequate sexual education in schools, which doesn’t thoroughly cover contraception or reproductive health. Addressing this, from 2016 to 2018, we launched a stigma-reduction intervention (quasi-experimental design with pre- and posttest) targeting Kenyan school adolescents (financed by two FORTE grants and one from VR-link), aiming to determine if comprehensive sexual education could diminish stigma around abortions and contraceptives. This study, a first of its kind in Kenya, demonstrated the effectiveness of our approach. From 2018 to 2020, extensive efforts were made in collaboration with KMET and the Ministry of Education (MoE) and MoH to enhance age-appropriate CSE in Kisumu, involving health care providers and secondary school teachers. I supervised a PhD candidate during this period (she defende her thesis 2020), and several master students.

In 2020-2023 I am part of a research team at Uppsala University, investigating women's experience of abortion and contraceptive use/access during the Covid-19 Pandemic. A multicenter survey (2021) among 600 women, which has rendered in several papers with regard to contraceptive counselling access and use, reasons for none-use, decision-making on abortion, and exposure to violence among abortion seeking women.

In 2022-2023 I am one of two principle investigators conducting a implementation research project in a rural area of Sweden (finannced by municipality and MIUN grants), with the aim to promote early and coordinated efforts to promote health among schoolchildren (6-16 years). Cooperation among stakeholders—schools, healthcare providers, social services—becomes even more vital in remote areas with limited resources to promote mental health among schoolchildren. In such areas, where access to mental health support is scarce, collaboration ensures that every available resource is optimized. Schools can incorporate mental health awareness into their curriculum, healthcare providers can offer individual solutions, and social services can leverage community networks. This implementation research helps to identify locally relevant strategies, adapting interventions for maximum effectiveness in promoting mental well-being despite resource constraints.

2023- ongoing. I am the principle investigator in an implemetation research with the aim to evalute the implementation of SEXIT (SEXual Identification Tool) at student health clinics in the County of Jämtland in collaboration with the Region of Jämtland Härjedalen (financed by grants from Jämställdhetsmyndigheten). It's intended to be a tool that helps promote healthy attitudes and behaviors related to sex and relationships while addressing important issues like consent, communication, and preventing sexual violence, among adolescents. I am a supervisor of a PhD student.

Outside of my research endeavors, I served as a senior analyst at the Public Health Agency in Sweden from 2007 to 2019. I led various projects and reports, focusing on sexual and reproductive health, overarching public policies, and public health reporting. The agency, accountable to the Ministry of Health and Social Affairs, coordinates public health issues nationally, while also maintaining international commitments, especially related to the sustainable development goals of the Agenda 2030. I was the project leader of the report regional and local public health comparisons ("Öppna jämförelser folkhälsa 2019"), presenting 39 public public health indicators reflecting health outcomes, social and living conditions, and lifestyle habits. These indicators help in understanding broader trends and the disparities among various demographics based on gender, age, and education. Additionally, I have been dedicated to implementing public health policies and promoting health literacy, deemed vital by WHO to achieve the goals of Agenda 2030. Some of my publications originate from my tenure at the National Agency of Public Health.

Teaching and tutoring

Programansvarig för Magisterutbildningen i Folkhälsovetenskap, och har kursansvar för Strategiskt folkhälsoarbete (AV), Projektledning (Gr), Ämnesfördjupning (AV), och Vetenskapligt arbete (AV).

Studentlitteratur/kurslitteratur

Etik för barnmorskor (kapitel om etik och abort). Studentlitteratur (2021), artikelnr: 40367-01. Etik för barnmorskor - 9789144133324 | Studentlitteratur

Mixed-Methods Approach to Address Abortion 
Stigma: A Necessity in Resource-Limited 
Settings Where Safe Abortion Is Restricted. SAGE Research Methods Cases: Medicine and Health (2020): https://methods.sagepub.com/case/mixed-methods-abortion-stigma-resource-limited-settings-safe-restricted

Publikationer Marlene Makenzius: bibliometrics.ki.se/public/publicProfile/2971

Other information

Research areas related to Agenda 2030

Goal 3 - Good health and well-being

Goal 5 - Gender equality 

Goal 10 - Reduced inequalities

Goal 16 - Peace, justice and strong institutions 

 

1. Miranda Håkansson, Rahel Abebe Mamo, Haroon Bayani Parwani, Beatrice Otieno & Marlene Makenzius (2023) Unmet Needs for Comprehensive Sexuality Education: A Qualitative Study Among Secondary School Students in Western Kenya, American Journal of Sexuality Education, DOI: 10.1080/15546128.2023.2189194

3. A stigma-reduction intervention targeting abortion and contraceptive use among adolescents in 
Kenya—a quasi-experimental study Makenzius M, Rehnstrom Loi U, Otieno, B, Oguttu M. SEXUAL AND REPRODUCTIVE HEALTH MATTERS 2022, IN PRESS.

4. Multiple induced abortions - implications for counselling and contraceptive services from a multi-centre cross-sectional study in Sweden
Obern C, Ekstrand Ragnar M, Tydén T, Larsson M, Niemeyer Hultstrand J, Gemzell-Danielsson K, Sundström-Poromaa I, and *Makenzius M. 
Eur J Contracept Reprod Health Care. 2023 . IN PRESS

5. PMID: 36459054
Women's decision-making related to induced abortion - a cross sectional study during a period of Covid-19 pandemic, in Sweden.
Makenzius M, Obern C, Tydén T, Larsson M, Gemzell-Danielsson K, Sundström-Poromaa I, Ekstrand Ragnar M.
Eur J Contracept Reprod Health Care. 2023 Feb;28(1):44-50. doi: 10.1080/13625187.2022.2150047. Epub 2022 Dec 2.
PMID: 36459054

6. PMID: 35332034
Induced abortion and access to contraception in Sweden during the COVID-19 pandemic.
Niemeyer Hultstrand J, Törnroos E, Gemzell-Danielsson K, Larsson MI, Makenzius M, Sundström-Poromaa I, Tydén T, Ekstrand Ragnar M.
BMJ Sex Reprod Health. 2022 Oct;48(4):311-312. doi: 10.1136/bmjsrh-2022-201464. Epub 2022 Mar 24.
PMID: 35332034 No abstract available.

7. PMID: 33665607
Stigma surrounding contraceptive use and abortion among secondary school teachers: A cross-sectional study in Western Kenya.
Meurice ME, Otieno B, Chang JJ, Makenzius M.
Contracept X. 2021 Feb 7;3:100062. doi: 10.1016/j.conx.2021.100062. eCollection 2021.
PMID: 33665607 Free PMC article.

8. PMID: 32295574
Social judgments on abortion and contraceptive use: a mixed methods study among secondary school teachers and student peer-counsellors in western Kenya.
Håkansson M, Super S, Oguttu M, Makenzius M.
BMC Public Health. 2020 Apr 15;20(1):493. doi: 10.1186/s12889-020-08578-9.
PMID: 32295574 Free PMC article. Clinical Trial.

9. PMID: 31951913
Contraceptive uptake among post-abortion care-seeking women with unplanned or planned pregnancy in western Kenya.
Rehnström Loi U, Klingberg-Allvin M, Gemzell-Danielsson K, Faxelid E, Oguttu M, Makenzius M.
Sex Reprod Healthc. 2020 Mar;23:100486. doi: 10.1016/j.srhc._319519132020.100486. Epub 2020 Jan 8.

10. PMID: 31533554
Abortion and contraceptive use stigma: a cross-sectional study of attitudes and beliefs in secondary school students in western Kenya.
Rehnström Loi U, Otieno B, Oguttu M, Gemzell-Danielsson K, Klingberg-Allvin M, Faxelid E, Makenzius M.
Sex Reprod Health Matters. 2019 Nov;27(3):1652028. doi: 10.1080/26410397.2019.1652028.
PMID: 31533554 Free PMC article.

11. PMID: 31492147
Stigma related to contraceptive use and abortion in Kenya: scale development and validation.
Makenzius M, McKinney G, Oguttu M, Romild U.
Reprod Health. 2019 Sep 6;16(1):136. doi: 10.1186/s12978-019-0799-1.
PMID: 31492147 Free PMC article. Clinical Trial.

12. PMID: 31326762
Health disparities based on neighbourhood and social conditions: Open Comparisons-an indicator-based comparative study in Sweden.
Makenzius M, Skoog-Garås E, Lindqvist N, Forslund M, Tegnell A.
Public Health. 2019 Sep;174:97-101. doi: 10.1016/j.puhe.2019.06.003. Epub 2019 Jul 18.
PMID: 31326762

13. PMID: 30096148
Contraceptive uptake in post abortion care-Secondary outcomes from a randomised controlled trial, Kisumu, Kenya.
Makenzius M, Faxelid E, Gemzell-Danielsson K, Odero TMA, Klingberg-Allvin M, Oguttu M.
PLoS One. 2018 Aug 10;13(8):e0201214. doi: 10.1371/journal.pone.0201214. eCollection 2018.
PMID: 30096148 Free PMC article. Clinical Trial.

14. PMID: 29972099
Co-creation to scale up provision of simplified high-quality comprehensive abortion care in East Central and Southern Africa.
Klingberg-Allvin M, Atuhairwe S, Cleeve A, Byamugisha JK, Larsson EC, Makenzius M, Oguttu M, Gemzell-Danielsson K.
Glob Health Action. 2018;11(1):1490106. doi: 10.1080/16549716.2018.1490106.
PMID: 29972099 Free PMC article.

15. PMID: 29527357
Human rights versus societal norms: a mixed methods study among healthcare providers on social stigma related to adolescent abortion and contraceptive use in Kisumu, Kenya.
Håkansson M, Oguttu M, Gemzell-Danielsson K, Makenzius M.
BMJ Glob Health. 2018 Mar 5;3(2):e000608. doi: 10.1136/bmjgh-2017-000608. eCollection 2018.
PMID: 29527357 Free PMC article.

16. PMID: 29018067
Post-abortion care with misoprostol - equally effective, safe and accepted when administered by midwives compared to physicians: a randomised controlled equivalence trial in a low-resource setting in Kenya.
Makenzius M, Oguttu M, Klingberg-Allvin M, Gemzell-Danielsson K, Odero TMA, Faxelid E.
BMJ Open. 2017 Oct 10;7(10):e016157. doi: 10.1136/bmjopen-2017-016157.
PMID: 29018067 Free PMC article. Clinical Trial.

17. PMID: 27539801
Time to act-comprehensive abortion care in east Africa.
Cleeve A, Oguttu M, Ganatra B, Atuhairwe S, Larsson EC, Makenzius M, Klingberg-Allvin M, Paul M, Kakaire O, Faxelid E, Byamugisha J, Gemzell-Danielsson K.
Lancet Glob Health. 2016 Sep;4(9):e601-2. doi: 10.1016/S2214-109X(16)30136-X.
PMID: 27539801 Free article. No abstract available.

18. PMID: 25789926
Swedish public health policy: Impact on regional and local public health practice and priorities.
Makenzius M, Wamala S.
J Public Health Policy. 2015 Aug;36(3):335-49. doi: 10.1057/jphp.2015.3. Epub 2015 Mar 19.
PMID: 25789926

19. PMID: 24199440
[Sweden has the highest abortion rate among the Nordic countries. Unwanted pregnancies should be seen in a holistic perspective--individuals, health care, community].
Makenzius M, Tydén T, Darj E, Larsson M.
Lakartidningen. 2013 Sep 18-24;110(38):1658-61.
PMID: 24199440 Review. Swedish. No abstract available.

20. PMID: 22913927
Autonomy and dependence--experiences of home abortion, contraception and prevention.
Makenzius M, Tydén T, Darj E, Larsson M.
Scand J Caring Sci. 2013 Sep;27(3):569-79. doi: 10.1111/j.1471-6712.2012.01068.x. Epub 2012 Aug 22.
PMID: 22913927

21. PMID: 22758772
Women and men's satisfaction with care related to induced abortion.
Makenzius M, Tydén T, Darj E, Larsson M.
Eur J Contracept Reprod Health Care. 2012 Aug;17(4):260-9. doi: 10.3109/13625187.2012.688149. Epub 2012 Jul 3.
PMID: 22758772

22. PMID: 22554137
Existential experiences and needs related to induced abortion in a group of Swedish women: a quantitative investigation.
Stålhandske ML, Makenzius M, Tydén T, Larsson M.
J Psychosom Obstet Gynaecol. 2012 Jun;33(2):53-61. doi: 10.3109/0167482X.2012.677877.
PMID: 22554137

23. PMID: 22462801
Early onset of sexual intercourse is an indicator for hazardous lifestyle and problematic life situation.
Makenzius M, Larsson M.
Scand J Caring Sci. 2013 Mar;27(1):20-6. doi: 10.1111/j.1471-6712.2012.00989.x. Epub 2012 Mar 28.
PMID: 22462801

24. PMID: 22307996
Risk factors among men who have repeated experience of being the partner of a woman who requests an induced abortion.
Makenzius M, Tydén T, Darj E, Larsson M.
Scand J Public Health. 2012 Mar;40(2):211-6. doi: 10.1177/1403494811435496. Epub 2012 Feb 3.
PMID: 22307996

25. Mixed-methods approach to address abortion stigma: A necessity in resourcelimited settings where safe abortion is restricted. Makenzius, M. First author
(2020). SAGE Research Methods Cases. https://dx.doi.org/10.4135/9781529740547

26. Post Abortion Women’s Perception on Contraceptive Counselling Provided By 
Service Providers: A Qualitative Study In Kisumu County, Kenya. Odera T, Justus 
O, Ephantus K, Oguttu M, Faxelid E, Makenzius, M. Last author Afr. J. Health 
Sci. 2019; 32(2): 49 – 63. https://www.ajol.info/index.php/ajhs/article/view/195714

27. Task Shifting and Sharing on Contraceptive Counselling Services between 
Midwives and Physicians A Randomized Control Trial in Kisumu County, Kenya. 
Odera T, Justus O, Ephantus K, Faxelid E, Makenzius M, Oguttu M. Afr. J. Health 
Sci. 2020; 32(5): 28 – 37. https://www.ajol.info/index.php/ajhs/article/view/199461

Research projects

Current

Physical Activity on Prescription (PAP) – Opportunities and Barriers in Region Jämtland Härjedalen

Sexual health and freedom from violence among young people in the Region of Jämtland Härjedalen

Finished

Collaboration to promote children's and young people's health, learning and to create sense of security - opportunities and obstacles considering the context of a rural area.