Anticipated future increases in the rates of growth of African pcpJ.1ations \OiOUld be heigthened by declines in the levels of infertility. Infertility accounts for 60 percent of variation in total fertility and is associated with a loss of one child per wanan on average in 18 sub-Saharan countries with relevant data. The single major cause of infertility in these countries, in all probability, is gonorrhea through tubal infection and occlusion in \'QIlen. Failure to address the problem of infertility in the near term can ultimately delay Africa's fertility transition, bcause uncertainty in childbearing inhibits response to intrinsic and extrinsic pressures to reduce fertility goals.