Since the 1970s, twin birth rates have increased sharply in developed countries. In Africa, where the rate is the highest globally, its evolution
and variation are poorly understood. This article aims to estimate the twinning rate in sub-Saharan African (SSA) countries throughout
1986–2016 and analyze its spatial, temporal, and ethnic variations. It also seeks to identify social and demographic factors associated with a
high probability of twin births and outline a forecast of the twinning rate. We used data from 174 Demographic and Health Surveys from
42 countries. We supplemented them with the UN World Population Prospects (WPP). The twinning rate was calculated by reporting the
number of twin births per thousand total births. We used logistic regression to analyze the factors associated with twin births. We projected the
twinning rate based on WPP. The overall SSA twinning rate is 17.4 per 1000, but it has changed very little over time, and we expect it will grow a
little between 2015 and 2050, increasing at most from 17.4 per 1000 to 18.4 per 1000. We also show significant differences in the twinning rate
in SSA according to mother ethnicity. Most ethnic groups with high twinning rates belong to the large Bantu ethnic family. SSA remains the
‘land of twins’, with the twinning rate changing slowly. However, specific health policies must target twin births in SSA to address the public
health challenges they present.

Twins; Twin births; Twinning rate; Associated factors; Ethnicity; Projections; Sub-Saharan Africa