The conclusion reached in this examination of fertility and family formation patterns in sub-Saharan Africa is that researchers and policymakers cannot assume that a unique population program can be developed and be successful in all regions and cultures. Socioeconomic factors and cultural factors vary between and within regions. The effect of economic crisis and of AIDS transmission is unknown. Demographic transition theory has not effectively accounted for the lack of fertility decline in Africa. Mortality levels have declined but not fertility. Even with national family planning programs, women's use of contraceptives is low. There is a persistent preference for large families. Research has recommended policies which emphasize female education in order to lower the demand for children. Women's groups and grass roots mobilization must be engaged to promote and implement family planning. Women's autonomy in decision making needs to be encouraged by programs; economic independence from husbands needs to be secured for women. An overview is provided of the theoretical framework of fertility. Discussion focuses on factors affecting fertility in sub-Saharan Africa: the impact on supply and demand factors from individual socioeconomic differences and the cultural context. Attention is also given to African reproductive trends, African population policies, and future recommendations and research needs. Africa has had the highest fertility in the world, i.e., 6-7 children/woman. There are short breast-feeding durations and short postpartum abstinence periods. Rwanda has the highest fertility currently and Kenya's fertility has dropped from the distinction of being the highest. Population growth is the highest because of a decline in mortality. Data from the World Fertility Surveys and Demographics Surveys have helped to develop a more complex view of the interaction between demographic and economic factors and fertility decline. Proximate determinants have been identified. By 1984 most governments had developed explicit population policies on birth spacing and integrated programs, with appeal to the educated and urban population.