It is widely accepted that while the fertility transition is underway in sub-Saharan Africa, the pattern of change differs widely in both time and space. This paper examines the case of Ghana, regarded as the vanguard in the West African fertility transition. Based largely on analyses of Demographic and Health Survey data as well as localised studies, significant patterns emerge. One puzzling finding is that the increase in modern contraception usage has not kept pace with the declines in fertility. The paper suggests that this mismatch can be explained either by an increase in induced abortions, reduced exposure to sexual relations (perhaps due to HIV), or misreporting of contraceptive use. The paper also highlights the considerable geographical diversity in the ongoing fertility transition. The Northern region is still in the pre-transition stage, with little decline in fertility to date. In contrast, the pace of decline has been very rapid in the Greater Accra region. The factors underlying these patterns and the future trajectory of the fertility transition are discussed. It is argued that the fertility transition may be more leisurely in the near future than in the recent past. Among the factors working against future fertility decline are the stability in the infant mortality rate, the stall in fertility desires, and the low patronage of modern contraceptives especially in rural areas.