Pests have a major impact on cacao production: estimates of losses due to pest and disease range from 30% to 40%. The use of chemical inputs, for example, pesticides and fertilizers, for pest and disease control and production enhancement, respectively, can have numerous negative impacts on the environment and human health. An integrated and holistic approach is therefore required to enhance and sustain crop production. This chapter presents the main insect pests attacking cacao in each of the three principal production regions: the Americas, Africa and Asia, and provides general information on control measures adopted for each of the main insect pests. The chapter also presents case studies that showcase how research can help to develop more sustainable and environmentally friendly control measures. Finally, the chapter discusses some of the non-traditional areas in which research should focus to overcome the challenges posed by insect pests.