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 byproduct of social and economic development together with, in some cases, strong government pressures. This article probes more deeply into this experience, seeking to identify common features of development design and administration that underlay it. 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. The study is mainly focused on seven countries: Taiwan and South Korea (“tiger” economies), Thailand, Malaysia, and Indonesia (“second wave” countries), and China and Vietnam (“market-Leninist” economies). The period is roughly from the 1960s to the 1990s.