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National census data show that the modern demographic transition—the recent trend toward declining mortality and fertility—is well underway in most countries. A different picture emerges when data from small-scale societies in unindustrialized parts of the world are considered. Many of these small-scale societies are also adapting to rapid changes in their subsistence economies. In this article, we examine the relationship between the pace of acculturation, infant mortality, and fertility levels among Pumé foragers and horticulturalists, two related groups of native South Americans. During the earliest stages of acculturation, Pumé horticulturalists experience not only a rapid drop in infant mortality but also a rise in birth rates. An anthropological view of demographic transitions provides important insight into how small-scale societies are affected by exposure to the labor market economy and has practical applications to effective development initiatives and public health policies. [ABSTRACT FROM AUTHOR]