Inland small-scale fisheries provide important ecosystem services in sub-Saharan Africa as a source of nutritious food to over 200 million people and offer avenues for countries to attain Sustainable Development Goal 2. However, there is a dearth of knowledge on the pathways of fish to food security, especially in the case of inland small-scale fisheries, which are often underrepresented in research and policy discussions. We review the literature from 2010 to the present to assess how fish food systems, specifically those associated with inland small-scale fisheries in sub-Saharan Africa, relate to the four pillars of food security: availability, access, utilization, and stability, as well as women's empowerment. We offer an assessment of the extent to which each of these pillars of food security has been thoroughly conceptualized and investigated in the literature, identifying important avenues for future research. Overfishing, post-harvest losses, and trade influences drive fish availability in many contexts. Income benefits from participating in small-scale fisheries were important for attaining access to fish for food security and other important livelihood outcomes. Few studies addressed utilization and stability compared to availability and access pillars. Further, few studies examined how gender shapes outcomes of women's empowerment. The results lead to the proposed research agenda of focusing on all pillars of food security that can enhance the sustainable contribution of inland small-scale fisheries to food security.