Marlene Makenzius, a midwife with a MPH and a PhD in medical sciences. An affiliated researcher at the Department of Global Public Health, and at the Department of Women's and Children's Health. She is also senior analyst at the Public Health Agency, Sweden.

Marlene Makenzius

Affiliated to research

An affiliated researcher in the field of SRHR, at the Department of Global Public Health and at the Department of Women's and Children's Health. A senior analyst at the Public Health Agency, Sweden.

About me

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.

I hold my PhD degree in medical sciences from Uppsala University (2012), Sweden. I am also a registered Nurse Midwife, District Nurse 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 am a senior analyst at the Public Health Agency (since 2007), 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. The participants were recruited from 13 clincs 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 (2014-2020). 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 study 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 date (April 2020) the first regime treatment for first trimester abortion at the hospitals involved in the study (if the medical criteria’s are met).

Unplanned pregnancies often occurred to 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; therefore, women are at risk because they avoid learning about contraceptives despite their unmet need for contraceptive education. Stigmatizing attitudes toward adolescent pregnancy and young motherhood contribute to major public health concerns in low- and middle-income countries, and so in Kenya. School-based CSE in Kenya does not include details on contraception, safe sex, or reproductive health; thus, the information lacks comprehensiveness. Based on the results from the PAC study, my research team desired to gain a deeper understanding of adolescents’ attitudes regarding sexual intercourse, contraceptive use, and unintended pregnancy.

In 2016, Karolinska Institutet in Sweden and the KMET, 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 (2015-01194) and network grants from the Swedish Research Council (2016-05670). The main study was a cluster randomized trial that took place from 2016 to 2018 with the aim of determining whether school-based comprehensive sexual education (CSE) intervention (8 h) would decrease the stigma surrounding abortions and contraceptive use among adolescents in Kisumu ( 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.

Aside my research I am a senior analyst at the Public Health Agency in Sweden (since 2007). I have been the project leader for several reports and missions in sexual and reproductive health, and overarching public health analyzing and 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 public health issues. 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 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.

Across the population, levels of health are good and have, in some areas, improved over recent decades. However, some significant health disparities remain, and in some cases increased. Health disparities related to the level of education are often larger than those between women and men, and there are larger differences within a region than between regions. During 2019/20 I have also worked with health literacy, which 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.

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