Introduction <p>Scientific research has shown a remarkable improvement toward achieving the fifth sustainable development goal (SDG 5), intended to empower women and promote gender equality. However, the international community still struggles to reach consensus on upholding women’s reproductive health and rights. This review aimed to identify and map literature on African women’s health decision autonomy concerning maternal health care.</p> Methods <p>Qualitative and quantitative peer-reviewed African literature was searched from PubMed, Medline, Embase, and Web of Science. Of the 4,362 identified articles, 70 met the inclusion criteria and were sources of evidence in this review.</p> Results <p>Findings showed that the partners/husbands were the sole maternal health decision-makers in most settings. Apart from the women and their partners, family and other community members were also part of the decision-making process. Demographic and socio-cultural factors determined women’s health decision autonomy, while women’s health decision autonomy impacted sexual and reproductive health and the utilization of maternal health care services.</p> Policy implications <p>There is a paucity of evidence on the interventions aimed at improving women’s health decision-making in Africa. Future research must focus on testing programs to improve women’s health decision-making autonomy within the African context.</p>