Marlene Makenzius

About me

I am a lecture and researcher at MIUN, Dept. Health Sciences. I am responsible for the masterprogram in public health sciences. I am also an affiliated researcher in the objective of sexual and reproductive health and rights (SRHR), at the Department of Global Health, and at the Department of Women's and Children's Health, at Karolinska institutet.

I hold my PhD degree in medical sciences from Uppsala University (2012), Sweden. I am also a registered Nurse Midwife (1997), District Nurse (1999) and I hold a master degree in Public Health Sciences (2008), and a master degree in Quality Management and Leadership (2009). I was awarded for a post-doctoral position at Karolinska institutet, and at the University of Nairobi (2014-2018). Aside my research I have been a senior analyst at the Public Health Agency (2007- 2019), Sweden.

Research description

My initial research regarded sexual and reproductive health among adolescents, in particulars male adolescents and youth friendly clinics, in Sweden. My PhD research focused on women and men’s experiences and needs in relation to induced abortion in Sweden, and their views on the prevention of unintended pregnancies (2009-2012). It was explored among 798 women and their partner’s (n=600). The participants were recruited from 13 clinics in Sweden. Both quantitative and qualitative methods were used. Both individual and societal challenges were implied: women and men experiencing repeat abortion appeared more disadvantaged and abortion involved complex aspects beyond medical procedures and routines. Thus, abortion care should be continuously evaluated to ensure care satisfaction, safety, and contraceptive adherence. Preventive efforts should focus on both individual and societal measures. My post-doctoral research addressed treatment of complications due to unsafe abortion, contraceptive use, and stigma surrounding abortion and contraception, in Kisumu, Kenya (2014-2022). Western Kenya, where Kisumu is situated, has a youthful population, 43% are below the age of 15 years. The Kisumu Medical and Education Trust (KMET) and Karolinska Institutet, in collaboration with the Ministry of Health in Kisumu County, conducted a Randomized Controlled Trial (RCT) in 2013–2016 to assess the effectiveness of midwives’ administration of Misoprostol (a drug to eliminate products from the uterus) to women with incomplete abortions who were seeking postabortion care (PAC) compared against physicians’ care. PAC contraceptive counseling and uptake were also investigated. Approximately 1,100 women were treated during the study period. The results showed that midwives’ use of Misoprostol to treat incomplete abortions is as effective, safe, and acceptable for women as when Misoprostol was administered by physicians. In addition, PAC-seeking women seemed highly motivated to use contraceptives, yet one quarter of this population declined contraceptives, most of them young women, and at a 3-month follow-up, a further quarter of women had discontinued contraceptive use. Implants, intrauterine devices, and permanent methods were rarely used. Misoprostol is up to April 2020 the first regime treatment for first trimester abortion at the hospitals involved in the study (if the medical criteria’s were met). Suggesting that our research project achieved a permanent policy change within these research settings. Unplanned pregnancies often occurred to Kenyan women who were young, unmarried, and who concealed the pregnancy, and visited a PAC clinic alone. Social stigma surrounding contraception and abortion may prompt women to hide a pregnancy. Stigmatizing attitudes toward adolescent pregnancy and young motherhood contribute to major public health concerns in low- and middle-income countries, and so in Kenya. This problem forces adolescents and women at risk because they avoid learning about contraceptives due to stigma, despite their unmet need for contraception. School-based CSE in Kenya does not include details on contraception, consent, or reproductive health; thus, the information lacks comprehensiveness. Based on the results from the RCT about PAC, my research team desired to gain a deeper understanding of adolescents’ attitudes regarding sexual intercourse, contraceptive use, and unintended pregnancy. In 2016, Karolinska Institutet and KMET in Kenya, in collaboration with the MoH and the Ministry of Education (MoE), began studying the stigma of abortion and contraceptives (SAC) in Kisumu County. I was granted postdoctoral grants from the Swedish Research Council for Health, Working Life and Welfare - FORTE (2015-01194) and network grants from the Swedish Research Council - VR (2016-05670). The main study was a stigma-reduction intervention targeting abortion and contraceptive use among adolescents in Kenya—a quasi-experimental study that took place from 2016 to 2018 with the aim of determining whether school-based comprehensive sexual education (CSE) intervention (9 h) would decrease the stigma surrounding abortions and contraceptive use among adolescents in Kisumu (ClinicalTrial.gov NCT03065842). In view of the inherent sensitivity of this research topic—adolescents’ attitudes regarding sexual intercourse, contraceptive use, and unintended pregnancy—we chose a mixed-methods design. The CSE intervention was effective (compared to CSE provided as usual at the control school). To our knowledge, no similar study has been conducted in Kenya. Thorough dissemination work has been done together with KMET and the MoE (2018-2020) to improve age appropriate CSE in Kisumu. The project also targeted health care providers, and secondary school teachers. Aside my research I have been a senior analyst at the Public Health Agency in Sweden (2007-2019). I have been the project leader for several reports and missions in sexual and reproductive health, overarching public policies, and public health reporting. The Public Health Agency of Sweden is a government agency accountable to the Ministry of Health and Social Affairs, and has a national responsibility for the coordination for public health issues in Sweden. The Agency has international commitments and partnerships, not least regarding the sustainable development goals in the Agenda 2030. My recent work at the agency addressed regional comparisons public health (Öppna jämförelser folkhälsa 2019). It is an indicator-based comparative study, presenting 39 public health indicators. The indicators reflect health outcomes as well as social and living conditions, and lifestyle habits. Social conditions include socioeconomic factors such as education, work and occupation, while living conditions relate to the living environment, recreation, a sense of being able to influence your situation and levels of security and trust. Living conditions are affected by social conditions. Lifestyle habits relate to everyday behaviours that are often affected by social conditions and living conditions. The comparisons are between municipalities and between regions. However, in order to understand the indicators in a wider context, trends over time at the national level and how the outcome is distributed between different groups based on gender, age and educational background characteristics are presented. I have also been committed to work with the implementation of the public health policy, and health literacy. Health literacy is considered by the WHO a key to reach the goals in the Agenda 2030, i.e. a necessary element for achieving health equity. Some of my scientific publications are based on my work at the National Agency of Public Health.