Objective: This paper examines different child care arrangements utilized by working families in countries undergoing major socio-economic transitions, with a focus on modeling parental decisions to leave children home alone. Method: The study interviewed 537 working caregivers attending government health clinics in Botswana, Mexico, and Vietnam. Analyses involve descriptive statistics, content analysis, and ethnographic decision modeling. Results: In one-half of the families in Botswana, over one-third of the families in Mexico, and one-fifth of the families in Vietnam, children are left home alone on a regular or occasional basis. Moreover, 52% of families leaving children home alone relied on other children to help with child care. Parental unavailability and poor working conditions, limited support networks, inability to afford child care, neighborhood safety, and children's age are critical factors in parents' decisions to leave children home alone. Children also may remain home alone or without quality supervision when informal child care providers fail to provide care. Seldom their preferred choice, parents identified risks (e.g., increasing unintentional injuries, loneliness, and poor behavioral and developmental consequences) and benefits (e.g., strengthening child independence and sibling relations) of this arrangement. Conclusions: Poverty, social integration, local norms, and child development frame parents' decisions of care. Insufficient societal support to working families frequently resulted in unsafe child care arrangements and limited parental involvement in child education and health care. Current, comprehensive data on this phenomenon are needed to inform social services and policies in countries undergoing major socio-economic transitions. Practice implications: Existing attention to children home alone has mostly focused on the associated risks, injuries, and poor outcomes; consequently, this child care arrangement is often assessed as parental neglect. However, understanding why children are left home alone or under the supervision of another child is crucial to the development of suitable interventions. Findings from this study of parental decision-making in Botswana, Mexico, and Vietnam highlight the need to understand the etiology of each case to assess whether parents are seeking the best option among untenable choices, or if it is, indeed, a case of parental, caregiver, or societal neglect. (Contains 2 figures and 1 table.)