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POPULI. 1987; 14(1):39-47.This reevaluation of the demographic transition theory of Notestein (1945) presents a view of developing countries trapped in the 2nd stage and unable to achieve the economic and social gains counted upon to reduce births. Among the half of the world's countries that have not yet reached the demographic transition, 5 regions have growth rates of 2.2% or more yearly, or 20-fold per century, a are unable to prevent declining living standards and deteriorating ecological life-support systems. These are Southeast Asia (except Japan, China, and possibly Thailand and Indonesia), Latin America, the Indian subcontinent, the Middle East and Africa. In these countries, death rates will begin to rise, reversing the process of demographic transition. Examples of this phenomenon include 7 countries in West Africa with deteriorating agricultural and fuelwood yields, such that a World Bank study concluded that desertification is inevitable without a technological breakthrough. The elements of the life-support system, food, water, fuelwood and forests, are interrelated, and their failure will create "ecological refugees." When economic resources of jobs and income are added to biological resources, conflict and social instability will further hamper implementation of sound population policies. For the 1st time, governments are faced with the task of reducing birth rates as living conditions deteriorate, a challenge requiring new approaches. There are examples, such as China, where broad-based, inexpensive health care systems and well-designed family planning programs have encouraged small families without widespread economic gains. The most needed ingredient is leadership.