Marlene Makenzius

Universitetslektor|Senior Lecturer

Bakgrund

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

Forskningsområden

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

Forskning

I am a midwife and an associate professor in public health. Affiliated researcher at KI, Dept. Global Public Health and Dept. Women's and Children's Health.

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.

Research description
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. I collaborated 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 Vetenskapsrådet/Swedish Research Council). 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.

The findings from my postdoctoral research also highlighted profound social stigma surrounding abortion and contraceptive use in Kenya, 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, as a principle investigator (PI) 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 was the supervisor of about 10 students at advanced level (from USA, Chile, China, Sweden), and a PhD candidate (PhD exam 2021, Karolinska institutet).

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.

2022-2023: One of two project leader, evaluating the implementation of HLT (health, learning, safety) method at community level in Sollefteå, with the aim to promote mental health and well-being among school children. A collaborative method targeting professionals at school and student health clinics, social service and primary health care.

2023- ongoing: I am PI in a project with aim to valuate the implementation of the SExual Identification Tool (SEXIT) among professionals at youth friendly clinics in the region of Jämtland Härjedalen, in Sweden. Students are involved and one PhD candidate (financed by Jämtsälldhetsmyndigheten/Region JH och MIUN).

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.

Undervisning

Strategiskt folkhälsoarbete
Ämnesfördjupning (litteraturöversikt, projektplan)
Vetenskapligt arbete, avancerad nivå (magister och masters)
Projektledning
Folkhälsopolitik
Kvalitativ och kvantitativ metod
PhD course how to approach and apply academic writing

Övrigt

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

Forskningsområden kopplade till AGENDA 2030

Mål 3 God Hälsa

Mål 5 Jämställdhet

Mål 10 Minskad Ojämlikhet

Mål 16 Fredliga och Inkluderande Samhällen

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

Publikationer

Artiklar i tidskrifter

Klemets, L. & Makenzius, M. (2024). Exposure to violence and associated factors among abortion-seeking women – A multicentre study in Sweden during the Covid-19 pandemic. Sexual & Reproductive HealthCare, vol. 39  

Håkansson, M. , Mamo, R. A. , Parwani, H. B. , Otieno, B. & Makenzius, M. (2024). Unmet Needs for Comprehensive Sexuality Education : A Qualitative Study Among Secondary School Students in Western Kenya. American Journal of Sexuality Education, vol. 19: 1, ss. 42-57.  

Makenzius, M. , Rehnström Loi, U. , Otieno, B. & Oguttu, M. (2023). A stigma-reduction intervention targeting abortion and contraceptive use among adolescents in Kisumu County, Kenya : a quasi-experimental study*. Sexual and Reproductive Health Matters, vol. 31: 1  

Niemeyer Hultstrand, J. , Törnroos, E. , Tydén, T. , Larsson, M. , Makenzius, M. , Gemzell-Danielsson, K. , Sundström-Poromaa, I. & Ekstrand Ragnar, M. (2023). Contraceptive use among women seeking an early induced abortion in Sweden. Acta Obstetricia et Gynecologica Scandinavica, vol. 102: 11, ss. 1496-1504.  

Obern, C. , Ekstrand Ragnar, M. , Tydén, T. , Larsson, M. , Niemeyer Hultstrand, J. , Gemzell-Danielsson, K. , Sundström-Poromaa, I. & Makenzius, M. (2023). Multiple induced abortions–implications for counselling and contraceptive services from a multi-centre cross-sectional study in Sweden. European journal of contraception & reproductive health care, vol. 28: 2, ss. 119-124.  

Makenzius, M. , Obern, C. , Tydén, T. , Larsson, M. , Gemzell-Danielsson, K. , Sundström-Poromaa, I. & Ekstrand Ragnar, M. (2023). Women’s decision-making related to induced abortion–a cross sectional study during a period of Covid-19 pandemic, in Sweden. European journal of contraception & reproductive health care, vol. 28: 1, ss. 44-50.  

Niemeyer Hultstrand, J. , Törnroos, E. , Gemzell-Danielsson, K. , Larsson, M. , Makenzius, M. , Sundström Poromaa, I. , Tydén, T. & Ekstrand Ragnar, M. (2022). Induced abortion and access to contraception in Sweden during the COVID-19 pandemic. BMJ SEXUAL & REPRODUCTIVE HEALTH, vol. 48: 4, ss. 311-312.  

Meurice, M. E. , Otieno, B. , Chang, J. J. & Makenzius, M. (2021). Stigma surrounding contraceptive use and abortion among secondary school teachers : A cross-sectional study in Western Kenya. Contracept X, vol. 3

Rehnström Loi, U. , Klingberg-Allvin, M. , Gemzell-Danielsson, K. , Faxelid, E. , Oguttu, M. & Makenzius, M. (2020). Contraceptive uptake among post-abortion care-seeking women with unplanned or planned pregnancy in western Kenya.. Sexual & Reproductive HealthCare, vol. 23  

Håkansson, M. , Super, S. , Oguttu, M. & Makenzius, M. (2020). Social judgments on abortion and contraceptive use : a mixed methods study among secondary school teachers and student peer-counsellors in western Kenya. BMC Public Health, vol. 20: 1  

Rehnström Loi, U. , Otieno, B. , Oguttu, M. , Gemzell-Danielsson, K. , Klingberg-Allvin, M. , Faxelid, E. & Makenzius, M. (2019). Abortion and contraceptive use stigma : a cross-sectional study of attitudes and beliefs in secondary school students in western Kenya.. Sexual and reproductive health matters, vol. 27: 3    

Makenzius, M. , Skoog-Garås, E. , Lindqvist, N. , Forslund, M. & Tegnell, A. (2019). Health disparities based on neighbourhood and social conditions : Open Comparisons-an indicator-based comparative study in Sweden. Public Health, vol. 174, ss. 97-101.

Makenzius, M. , McKinney, G. , Oguttu, M. & Romild, U. (2019). Stigma related to contraceptive use and abortion in Kenya : scale development and validation. Reproductive Health, vol. 16: 1, ss. 136

Klingberg-Allvin, M. , Atuhairwe, S. , Cleeve, A. , Byamugisha, J. K. , Larsson, E. C. , Makenzius, M. , Oguttu, M. & Gemzell-Danielsson, K. (2018). Co-creation to scale up provision of simplified high-quality comprehensive abortion care in East Central and Southern Africa. Global Health Action, vol. 11: 1    

Makenzius, M. , Faxelid, E. , Gemzell-Danielsson, K. , Odero, T. M. A. , Klingberg-Allvin, M. & Oguttu, M. (2018). Contraceptive uptake in post abortion care-Secondary outcomes from a randomised controlled trial, Kisumu, Kenya.. PLOS ONE, vol. 13: 8    

Håkansson, M. , Oguttu, M. , Gemzell-Danielsson, K. & Makenzius, M. (2018). 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. BMJ Global Health, vol. 3: 2  

Makenzius, M. , Oguttu, M. , Klingberg-Allvin, M. , Gemzell-Danielsson, K. , Odero, T. M. A. & Faxelid, E. (2017). 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. BMJ Open, vol. 7: 10    

Cleeve, A. , Oguttu, M. , Ganatra, B. , Atuhairwe, S. , Larsson, E. C. , Makenzius, M. , Klingberg-Allvin, M. , Paul, M. & et al. (2016). Time to act - comprehensive abortion care in east Africa. The Lancet Global Health, vol. 4: 9, ss. e601-e602.    

Makenzius, M. & Wamala, S. (2015). Swedish public health policy : Impact on regional and local public health practice and priorities. Journal of Public Health Policy, vol. 36: 3, ss. 335-349.  

Makenzius, M. , Tydén, T. , Darj, E. & Larsson, M. (2013). Autonomy and dependence : experiences of home abortion, contraception and prevention. Scandinavian Journal of Caring Sciences, vol. 27: 3, ss. 569-579.  

Makenzius, M. (2013). Sweden has the highest abortion rate among the Nordic countries. Unwanted pregnancies should be seen in a holistic perspective--individuals, health care, community. Läkartidningen, vol. 110: CEDC, ss. 1658-1651.

Makenzius, M. & Larsson, M. (2012). Early onset of sexual intercourse is an indicator for hazardous lifestyle and problematic life situation. Scandinavian Journal of Primary Health Care, vol. 27: 1, ss. 20-26.  

Liljas Stålhandske, M. , Makenzius, M. , Tydén, T. & Larsson, M. (2012). Existential experiences and needs related to induced abortion in a group of Swedish women : a quantitative investigation. Journal of Psychosomatic Obstetrics and Gynaecology, vol. 33: 2, ss. 53-61.  

Makenzius, M. , Tydén, T. , Darj, E. & Larsson, M. (2012). Risk factors among men who have repeated experience of being the partner of a woman who requests an induced abortion. Scandinavian Journal of Public Health, vol. 40: 2, ss. 211-216.  

Makenzius, M. , Tydén, T. , Darj, E. & Larsson, M. (2012). Women and men's satisfaction with care related to induced abortion. European journal of contraception & reproductive health care, vol. 17: 4, ss. 260-269.  

Makenzius, M. , Tydén, T. , Darj, E. & Larsson, M. (2011). Repeat induced abortion - a matter of individual behaviour or societal factors? : A cross-sectional study among Swedish women. European journal of contraception & reproductive health care, vol. 16: 5, ss. 369-377.  

Makenzius, M. , Gådin, K. G. , Tydén, T. , Larsson, M. & Romild, U. (2009). Male students' behaviour, knowledge, attitudes, and needs in sexual and reproductive health matters. European journal of contraception & reproductive health care, vol. 14: 4, ss. 268-276.  

Sidan uppdaterades 2023-11-23