Here the word karma-doṣaiḥ means “by faulty actions.” This refers to any activity, good or bad, performed in this material world — they are all contaminated, faulty actions because of material association. The foolish conditioned soul may think that he is offering charity by opening hospitals for material benefit or by opening an educational institution for material education, but he does not know that all such work is also faulty because it will not give him relief from the process of transmigration from one body to another. It is clearly stated here, sad-asan-miśra-yoniṣu. This means that one may take birth in a very high family or he may take his birth in higher planets, among the demigods, for his so-called pious activities in the material world. But this work is also faulty because it does not give liberation. To take birth in a nice place or a high family does not mean that one avoids undergoing the material tribulations, the pangs of birth, death, old age and disease. A conditioned soul under the spell of material nature cannot understand that any action he performs for sense gratification is faulty and that only his activities in devotional service to the Lord can give him release from the reaction of faulty activities. Because he does not cease such faulty activities, he has to change to different bodies, some high and some low. That is called saṁsāra-padavīm, which means this material world, from which there is no release. One who desires material liberation has to turn his activities to devotional service. There is no alternative.