The universal screening of newborn children for permanent hearing loss has become a standard health and educational service in many, if not most, developed countries. Developed nations, however, represent the minority of the world's population. Universal new born hearing screening (UNHS) is farless frequently available in developing countries where hearing loss is often disproportionately prevalent. This chapter considers the issues associated with the development of new born screening programs in developing countries, where the vast majority of the world's deaf children live. These issues include whether to screen all newborns or to employ a targeted approach of seeking only those children with known risk factors for hearing loss, the articulation of UNHS programs with appropriate support services for children and families, and the availability and quality of subsequent intervention in developing-country contexts. The question of economic affordability and the sustainability of expensive programs of screening in very poor countries is also considered, as are the ethical issues associated with providing (or not providing) access to such programs. It is concluded that successfully implemented UNHS programs stand to provide enormous benefits to deaf and hard-of-hearing (DHH) children and their families in developing countries. It is argued that such benefits will only accrue, however, if programs are well implemented and combined with adequate and effective follow-up.