Finlay JE, Efevbera Y, Ndikubagenzi J, Karra M, Canning D. Reframing the Measurement of Women’s Work: Focus Group Work in Burundi. Submitted.
Karra M, Subramanian SV, Fink G. Height among Healthy Children in Low- and Middle-Income Countries: An Assessment. The American Journal of Clinical Nutrition [Internet]. 2017;105 (1) :121-126. Publisher's Version
Karra M, Canning D, Foster S, Shah I, Senanayake H, Ratnasiri UDP. Quality of Antenatal Counselling and Acceptance of Postpartum IUD in Sri Lanka. Reproductive Health. 2017.
Karra M, Canning D, Wilde J. The Effect of Fertility Decline on Economic Growth in Africa: A Macrosimulation Model. Population and Development Review [Internet]. 2017. Publisher's Version
Canning D, Shah I, Pearson E, Pradhan E, Karra M, Senderowicz L, Baernighausen T, Spiegelman D, Langer A. Institutionalizing postpartum intrauterine device services in Sri Lanka, Tanzania, and Nepal: Study protocol for a cluster-randomized stepped wedge trial. BMC Pregnancy and Childbirth [Internet]. 2016;16 (1) :362. Publisher's Version
Karra M, Fink G, Canning D. Are We There Yet? Assessing the Burden of Travel on Maternal Health Care Utilization and Child Mortality in Developing Countries. International Journal of Epidemiology Blog [Internet]. 2016. Publisher's Version
Karra M, Canning D, Hu J, Ali M, Lissner C. Community-Based Financing of Family Planning in Developing Countries: A Systematic Review. Studies in Family Planning [Internet]. 2016;47 (4) :325-339. Publisher's Version
Karra M, Fink G, Canning D. Facility Distance and Child Mortality: A Multi-Country Study of Health Facility Access, Service Utilization, and Child Health Outcomes. International Journal of Epidemiology [Internet]. 2016. Publisher's VersionAbstract


Access to health facilities remains limited in many resource-poor settings, and women and their children often have to travel far to seek care. However, data on distance is scarce, and it is unclear whether distance is associated with worse child health outcomes. We estimate the relationships between distance to facility, service utilization, and child mortality in low- and middle-income countries.


Population-representative data are pooled from 29 Demographic and Health Surveys across 21 low- and middle-income countries. Multivariable logistic models and meta-analysis regressions are used to estimate associations between facility distance, child mortality, and health care utilization in the pooled sample as well as for each survey.


Compared to children who live within 1 km of a facility, children living within 2 km, 3 km, and 5 km of a facility have a 7.7% (95% CI: 0.927 – 1.251), 16.3% (95% CI: 1.020 – 1.327), and 25% (95% CI: 1.087 – 1.439) higher odds of neonatal mortality, respectively; children living farther than 10 km have a 26.6% (95% CI: 1.108 – 1.445) higher odds of neonatal mortality. Women living farther than 10 km from a facility have a 55.3%  lower odds of in-facility delivery compared to women who live within 1 km (OR: 0.447, 95% CI: 0.394 – 0.508).


Even relatively small distances from health facilities are associated with substantial mortality penalties for children. Policies that reduce travel distances and travel times are likely to increase utilization of health services and reduce neonatal mortality.

Canning D, Karra M, Wilde J, Newhouse DL, Eloundou-Enyegue P, Cho Y, Tien B, Robalino D, Wolff C. Economic Effects of the Demographic Dividend. In: Africa’s Demographic Transition: Dividend or Disaster? David Canning, Sangeeta Raja, and Abdo S. Yazbeck. Washington, DC: World Bank ; 2015.
Belohlav K, Karra M. Household Decisionmaking and Contraceptive Use in Zambia. Washington, DC: Population Reference Bureau; 2013. Publisher's Version
Chen L, Karra M. Expectations and the Social Network: Modeling Health Risk Perception among U.S. Adolescents. Barcelona Graduate School of Economics. 2011.
Sharma S, Karra M. Effective Policy Approaches to Address Inequities in Health: Examples from Jordan and Egypt, in IUSSP Health Equity Conference. ; 2009.