Fifty years of maternal mortality research in sub-Saharan Africa: a bibliometric analysis of trends, gaps, and opportunities for health equity

Abstract

Background Sub-Saharan Africa (SSA) continues to bear a disproportionate share of the global burden of maternal mortality (MM), despite decades of advocacy, research, and investment. Methods A bibliometric analysis investigated the evolution, volume, scope, and impact of maternal mortality research in SSA from 1975 to 2024, and presents a 50-year overview of peer-reviewed research on maternal mortality across SSA, identifying trends, prolific contributors, research gaps, and thematic shifts over the studied years. Moreover, using the Scopus database and VOSviewer, 1,985 publications were analyzed for authorship, institutional output, funding patterns, and coauthorship networks. Results The results revealed substantially increased publication output over time, particularly from Nigeria, South Africa, and Ethiopia, though the regions remain dependent on external funding and underrepresented in global high-impact journals (≤2.6% of global MM research outputs). There were some critical disparities in authorship, language, and thematic areas, including the translation of research findings into policy and practice. The most cited studies were grounded in subnational and underserved populations in SSA. The highest MM rates were found in Chad, Nigeria, and South Sudan (>1,000 deaths/100,000 live births), yet Chad and South Sudan have been studied in the fewest publications. Persistent causes of maternal mortality such as postpartum hemorrhage, hypertension in pregnancy, unsafe abortion, and infection have remained unchanged for decades, while health system and sociocultural barriers, including geographic inaccessibility, conflict and internal displacement, continue to worsen clinical outcomes, undermining progress. Conclusion This study underscores the broader systemic inequities in SSA that are reflected through progress in MM research and its outputs. Moreover, it calls for intersectional approaches in health, equity-driven, and transdisciplinary research and highlights the need for regional ownership, particularly in underrepresented areas. Capacity building and strengthening local research ecosystems through investments in research infrastructure and cross-sectoral partnerships to bridge research–policy gaps are recommended. Context-driven solutions are crucial to make tangible progress. Such solutions are aligned with the attainment of the Sustainable Development Goals and national health security plans.