Using Demographic and Health Survey (DHS) data for Ghana (1998), Kenya (1998), Tanzania (1996) and Zambia (1996), the paper has examined adolescent fertility and reproductive health in the four sub-Saharan African countries. Adolescent fertility is highest in Zambia and lowest in Ghana. Age specific fertility rate for adolescent females (15-19 years) ranges from 90‰ Ghanaian female adolescents to 158‰ Zambia adolescent females. Adolescent females’ contribution to total births ranges from 10% in Ghana to 13% in Zambia. At age 19 years, the percentages of adolescent females who have started childbearing were 61 in Tanzania, 59 in Zambia, 45 in Kenya and 32 in Ghana. In Ghana and Tanzania, a larger percentage of adolescent females than males have had sexual intercourse, while the reverse holds for Kenya and Zambia. Contraceptive knowledge is high but its use is low among adolescent males and females. Adolescent females have low levels of knowledge about some aspects of reproductive health. The proportions of adolescent females who correctly mentioned that a woman is most likely to conceive in the middle of the ovulatory cycle were 6.9% in Tanzania, 7.4% in Zambia and 13.4% in Kenya. The knowledge base in reproductive physiology of in and out-of-school adolescents should be strengthened. Sexuality education and other emerging issues such as human rights, harmful practices and violence should be integrated into population education and reproductive health programmes.