Across nations, Early Childhood Development (ECD) programs are of great interest to policymakers, service providers, and families. ECD programs are cross-cutting, often involving the health, education, child welfare, and other sectors, and their emphases shift over the early childhood years. In this paper, the authors propose equity as the construct central to the provision of ECD programs in an international context. Equity can be conceptualized relative to two components, access and quality. In the past there has been greater focus on building access to ECD program services with less emphasis placed on quality, particularly when programs are taken to scale in low- and middle-income (LAMI) countries. Quality is a key feature because when programs of low quality are provided, they are unlikely to generate the child and family outcomes intended. Moreover, quality is a relevant feature across all levels of the ecological system. To effect sustainable and meaningful change in ECD programs in developing countries, features of access and quality, must be addressed at each level of the ecological system. The paper presents a conceptualization of quality across settings and systems and identifies implications for policymakers, practitioners, and researchers on how they can work together to measure, improve and sustain program quality. (Contains 2 figures and 5 endnotes.) [Commentaries from Linda Biersteker, Belinda J. Hardin and Aisha K. Yousafzai are included. Commentaries are individually referenced.]