Ghana was the third country in sub-Saharan Africa, after Kenya and Mauritius, to adopt a formal and explicit Population Policy in 1969. But the consensus at a major conference held in 1989 to assess the policy after 20 years of its operation was that on balance it had failed to achieve its main objectives. This chapter examines the reasons why fertility remains almost at the same level as it was in 1969 with the Total Fertility Rate (TFR) only a little marginally lower at 6.4 in 1988 as compared with the previous 6.7 (G.D.H.S., 1988). The crude death rate had declined somewhat from the 20's to a level around 15 per 1000, but infant, child and maternal mortality remained at unacceptably high levels, and most importantly, the population growth rate which was projected to decline to 1.7 per cent by the end of the decade still remained at its high level of around 3.0 per cent. Modern contraceptive usage was disappointingly low at only 5 per cent (G.D.H.S., 1988).