Africa's Middle Stone Age (MSA) may have lasted almost half a million years, but its earliest expression is not yet well understood. The MSA is best known for innovations that appear in the archaeological record at various times after about 200,000 years ago with the first appearance of Homo sapiens. These novel behaviours embrace hafting technology, the use of compound paints and adhesives, ingenious lithic technology that included pressure flaking and the heat treatment of rock, the engraving of ochre and eggshell with geometric designs, the stringing of shell beads and the production of a wide range of bone implements. Such innovations might have been linked to new types of social behaviour stimulated by demographic pulses and movements within and out of the continent. Population shifts may have occurred repeatedly during the MSA. Southern African sites seem concentrated in the interior of the subcontinent before 130 kya. Thus, the florescence of MSA innovations described here appears to have coincided with the dispersal after 130 kya of populations from the interior to mountainous areas, but, more particularly, to the coastal stretches of the southern and western Cape. Coastal sites are the focus of much of southern Africa's research into the MSA and some of the continent's most esteemed sites are coastal ones, particularly those containing iconic Still Bay and Howiesons Poort technocomplexes. By 58 kya occupations tended once more to shift away from the southern coast and back into the interior, or to the eastern seaboard. Some of these later MSA sites have extensive footprints, implying population growth or repeated occupations. Regional and even local variability is characteristic of stone assemblages of the time, while sites seem to have fewer ornaments or decorated items than was formerly the case. The variability in late MSA lithic assemblages is matched by apparent flexibility in the timing of the transfer from the MSA to the Later Stone Age.