A Love of Language and Data Set the Stage for a Global Health Scholar

Mahesh Karra credits his early years in southwestern India for his love of languages. Living with his grandparents in Bangalore, he spoke English and Telugu at home and started learning Hindi in school. “People tend to be multilingual in India,” he notes. Karra joined his parents in the Washington, DC, suburbs, where he studied Spanish in high school. He picked up French as an undergraduate in Montreal, majoring in economics and Hispanic studies at McGill University, and credits his longstanding fieldwork in francophone Africa with improving his fluency. Still, he says, “I clearly speak French like someone who learned Spanish first.”

Karra, who joined the Columbia Mailman Heilbrunn Department of Population and Family Health as an associate professor in October 2025, investigates the relationships between demographic change, health and health policy, and economic development in low- and middle-income countries throughout Latin America, South Asia, and Sub-Saharan Africa. “I study the conditions around how women and couples in these settings make decisions about if and when to have children, how many to have across the life-course, and the timing and spacing of those pregnancies,” he says. “Most fundamentally, I’m thinking about how a woman decides whether and when she wants to have a child, how that affects her health, and whether she gets to stay in school, whether she gets to go to work and support her family.”

Karra’s research uses randomized controlled trials to evaluate the health and socioeconomic effects of improving access to family planning and maternal and child health services in India, Malawi, Nepal, Sri Lanka, and Tanzania. He also serves as founding director of the Program on Women’s Empowerment Research (POWER), which conducts evidence-based, policy-oriented research into the causes and effects of women’s empowerment on human well-being.

What sparked your curiosity about public health as a profession?

Karra: I’ve been quasi-indoctrinated in the field through my mom, Mihira Karra. Until last year, she was chief of the Research, Technology and Utilization Division for USAID’s Office of Population and Reproductive Health (these days, she has moved into the art world). As a kid, I liked math and science. I was also really interested in languages. After undergrad, I taught middle and high school math and economics in the Cleveland area and earned a master’s in economics at the Barcelona School of Economics. But I had no public health exposure until I started working. My mom pointed out that people in public health would really appreciate my analytical, quantitative skills. And I like problem-solving.

What problems are you trying to solve?

Karra: With support from the Hewlett Foundation, I started POWER—a consortium of five institutions where I wanted to incubate policy-oriented research—in 2020 as an assistant professor at Boston University. Now, my postdoc, Sarah Vincent, and I have brought it to Columbia. My partners and I are working to expand POWER’s research network at Columbia, and we hope the consortium can serve as a platform and model for developing effective research and policy partnerships in Sub-Saharan Africa. My broader interest is in thinking about how health affects outcomes that extend beyond the health sector, including education, employment, work, and livelihoods. At the same time, I am also interested in learning how programs and interventions that are often considered external to the health sector might contribute to health outcomes.

In addition to my field research and macroeconomic work on gender and women’s empowerment, I am also interested in issues of measurement in health and have worked on developing methods to correct for estimation when data are deliberately scrambled (such as masked location data). I have also been working on reconceptualizing family planning and reproductive health metrics to better reflect women’s contraceptive agency and preferences, including thinking about new ways to measure unmet need for family planning and unwanted family planning use.

How do your randomized controlled trials integrate policy and implementation?

Karra: One of my longer-term studies is in urban Malawi. Women there might want to have more children relative to women in the U.S., but they still may want to time and space their children to recover from pregnancy, invest in the child they just had, continue their education, or go back to work. Family planning in Malawi may be less about averting unwanted pregnancies (where women would have preferred to not want a child at all), and more about averting mistimed pregnancies (where women want to have a child later than when they did). We designed an intervention with the Ministry of Health and other partners in Malawi to give women in-home reproductive health counseling, free family planning services, and we also covered their cost of transportation to family planning clinics, door-to-door.

What surprised you?

Karra: When we started digging into what worked, we showed that counseling really helped women articulate what they wanted in terms of contraception, but it was transport that got them to the clinic and helped them realize their demand for family planning services. Women in our intervention group were far more likely to use contraception and had a 40 percent lower risk of a short birth interval within two years of their last birth. They also had children who were taller for their age and had better measures of early childhood cognitive development.

Let’s talk about your approach to teaching. You actually fund student research?

Karra: I train students in methods and field research, and also how to generate financing. I try to match their funding based on my own awards, so they can go live for three or four months in Malawi or India to experience fieldwork as I had. My contract with them is, “This is as much your project as it is mine.” Having an equal stake is how we get to see a project through. I think it’s important if they’re going to be in the field for them to see how the professional side of research and programs operates. So much just cannot be taught in the classroom. It has to be experienced by being there.

You and other economic demographers rely heavily on USAID’s Demographic and Health Survey Program (DHS). What are your concerns since the U.S. dismantled USAID?

Karra: USAID had such a dominant role—as the custodian and primary funder—in the management, oversight, and funding of the DHS in 80 countries. Now that the infrastructure has broken down, the question is, “What does the work look like when you no longer have a central planner?” Looking ahead, if there are coalitions or consortia collecting their own data, do they get to decide how data are collected, who has access, and the terms and conditions of that access? People are asking what’s coming next, under what structure data will be produced and shared, and what the architecture for global data management will look like. It’s not just USAID. Big data and AI also have the potential to transform the field of sexual and reproductive health.