As recently as 1988 the total fertility rate (TFR) in the Greater Accra Region of Ghana was 4.7 children per woman (compared to the national average of 6.4). The most recent (2008) Ghana Demographic and Health Survey estimates the TFR in the Greater Accra Region to be down to 2.5 (compared to 4.0 for the country as a whole). Within the core metropolis of the Greater Accra Region—the Accra Metropolitan Assembly or Accra Metropolis, our data (described below) suggest that fertility has dropped to near replacement level as of 2008–2009. Within Accra, as throughout the nation, this has been accomplished especially through a delay in marriage and reductions in exposure within marriage, accompanied by an increase in the use of abortion and modern contraceptives. At the same time, reported levels of abortion and contraceptive utilization remain substantially below what would be expected in order to achieve Accra’s low fertility. Thus, the exact proximate determinants of the decline remain a bit murky.