Addressing the sexual and reproductive health needs of adolescents in Sub-Saharan Africa is vital, given the devastating impact of AIDS, the high rates of unintended pregnancy and the risk that those pregnancies may lead to unsafe abortions. Protecting the health of adolescents is clearly important for the adolescents themselves. In addition, it is a critical public health priority. Increased investment in adolescent sexual and reproductive health can contribute to wider development goals, because it enables adolescents to become healthy, productive adults. This report presents key findings from nationally representative surveys conducted in 2004 among 12–19-year-olds in four African countries—Burkina Faso, Ghana, Malawi and Uganda—with the goal of guiding programs, policies and investments aimed at improving adolescent sexual and reproductive health.