Sub-Saharan Africa faces a historic challenge: to achieve economic and social progress while experiencing extraordinary population growth. With an estimated 1989 population of 512 million, the 42 countries of sub-Saharan Africa have the highest birth and death rates of any major world region. Throughout the region, population has outstripped economic growth since the mid-1970s. In addition, many African countries are experiencing an epidemic of AIDS (Acquired Immune Deficiency Syndrome). The extent and demographic impact of the epidemic are still unknown, but disturbing social and political effects are already being felt. The region's population growth will slow only when African couples begin to have fewer children. The Africans' preference for large families is deeply rooted in the culture and fed by the perceived economic benefits they receive from their children. Economic stagnation during the 1980s prompted many national governments to recognize that rapid population growth was hindering their socioeconomic development. The political climate has shifted away from pronatalist or laissez-faire attitudes toward official policies to slow population growth. The policy formation process is ponderous and beset with political and bureaucratic pitfalls. However, policy shifts in more and more countries combined with evidence of increased contraceptive use and fertility downturns in a few countries give some hope that the region's extraordinary population growth may have peaked and will start a descent. The document includes numerous black and white photographs, maps, graphs, and charts. (Author/JB)