Infant hearing screening is emerging rapidly as a silent global revolution for the early detection of children with congenital or early onset hearing loss to ensure timely enrollment in family-oriented intervention programs for the development of spoken language. This article examines the overriding and interrelated scientific, ethical and economic considerations for early hearing detection and intervention (EHDI) in developing countries against the backdrop of relevant resolutions of the World Health Assembly (WHA) and current global programs on early childhood development of the World Bank, United Nations Children's Funds (UNICEF) and the United Nations Educational, Scientific and Cultural Organization (UNESCO). The need to determine and develop culturally appropriate EHDI programs is indicated by the significant proportions of births that occur outside regular hospitals in some countries based on lessons from ongoing projects. The key challenges and possible approaches to building local service capacities to advance this vital, social, educational and public health initiative also are highlighted.