Document Type

Working Paper

Publication Date



The usual lessons drawn from East Asia’s striking experience of health and fertility transition concern the efficacy of well-designed government programs catering to an existing or ideationally stimulated demand. An alternative interpretation sees the demographic change—and the uptake of services—as a by-product of social and economic development together with, in some cases, strong government pressures. This Population Council working paper probes more deeply into this experience, seeking to identify common features of development design and administration that underlies it and to derive lessons for policies elsewhere. The broad sequence entailed, initially, establishment of an effective, typically authoritarian, system of local administration, providing (sometimes incidentally) a framework for promotion and service delivery in health, education, and family planning. Subsequent economic liberalization offered new opportunities for upward mobility—and greater risks of backsliding—but along with erosion of social capital and the breakdown or privatization of service programs.