Sugarcane is one of the most important and rapidly expanding industrial crops in Sub-Saharan Africa (SSA). Sugarcane production is a cornerstone of the national economy for some SSA countries such as Eswatini, accounting for a large portion of the Gross Domestic Product (GDP), foreign exchange generation, and employment creation. However, sugarcane production has multiple positive and negative outcomes at different levels. This chapter draws from actor-oriented political ecology and the theory of access to unravel the history, processes, and impacts of sugarcane production at the northern lowveld of Eswatini. The results show clearly that sugarcane production has had important impacts, which are distributed unevenly across different social groups. On the one hand, it has created a sugarcane elite at the national level that has controlled and manipulated the expansion of the sector, benefiting tremendously in the process. Similarly, at the local level, sugarcane production has benefited some plantation workers and irrigated smallholders. However, the development of irrigated smallholder sugarcane schemes happened in tandem with major reconfigurations in access to water and land, having important ramifications for community members not involved in irrigated sugarcane cultivation, especially in the onset of the severe 2015–2016 drought.