This chapter assesses the role of trade reform in IMF-supported, medium-term adjustment programs in sub-Saharan Africa, by reviewing multiyear arrangements with countries in that region during the 1990s. The chapter also provides an analytical framework for trade liberalization and introduces an index that classifies the relative aggregate restrictiveness of trade regimes. The review of sub-Saharan African countries assesses the initial degree of restrictiveness of each country’s trade regime, the targeted trade liberalization objectives in each program, and the degree of trade restrictiveness at the end of the program. The trade liberalization efforts in sub-Saharan African countries are compared with those of other regions that had IMF-supported medium-term programs during the same period. The chapter is in large part based on a recently completed comprehensive study of trade liberalization in IMF-supported programs. The study also discusses the main factors affecting trade policy targets, including in particular the impact of fiscal considerations.