Marlene Makenzius

Marlene Makenzius

Affiliated to Research
Visiting address: Widerströmska huset, hiss 1, plan 9 Tomtebodavägen 18A, 17177 Stockholm
Postal address: K6 Kvinnors och barns hälsa, K6 NOGRH Klingberg-Allvin, 171 77 Stockholm
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About me

  • 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.
    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

  • 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.
    *Publications*
    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 [1]/. Acta Obstetricia et Gynecologica
    Scandinavica, /
    2. 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
    [2]/. European journal of contraception &
  • reproductive health care, /vol.
    28: 2, pp. 119-124.
    3. Håkansson, M. , Mamo, R. A. , Parwani, H. B. , Otieno, B. &
  • Makenzius, M.
    (2023). Unmet Needs for Comprehensive Sexuality Education [3] : A
    Qualitative Study Among Secondary School Students in Western Kenya/. American
    Journal of Sexuality Education, /
    4. 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 [4]/. European journal of
    contraception &
  • reproductive health care, /vol. 28: 1, pp. 44-50.
    5. 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.
    6. 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.
    7. 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
    [1] https://urn.kb.se/resolve?urn=urn:nbn:se:miun:diva-49061
    [2] https://urn.kb.se/resolve?urn=urn:nbn:se:miun:diva-47786
    [3] https://urn.kb.se/resolve?urn=urn:nbn:se:miun:diva-48218
    [4] https://urn.kb.se/resolve?urn=urn:nbn:se:miun:diva-46688

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