Children, Water Insecurity, and Environmental Stress: Educational, Social, and Health Implications
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Abstract
Water is a fundamental human right and essential for the well-being of every person. Water insecurity affects children’s health, education, and social functioning, severely disrupting their development, well-being, and life chances. A recent global research agenda for children, outlining global priorities in WASH and Health, prioritizes the urgent interdisciplinary and global research needed to support coordinated action across sectors that can deliver improved WASH. To examine these links in more depth, this summary paper presents 15 evidence reviews exploring the pathways through which water insecurity impacts on children’s health, education, and development in low-resource settings. Together these reveal consistent themes in our understanding of these pathways; the groups of children at highest risk; and those elements of effective responses. While effective responses vary widely by context, the evidence points to some key components. Providing reliable household access to drinking water promotes health and development through different pathways and is essential to ensure children are protected from the WASH-related health risks of water insecurity. School-based water, sanitation, and hygiene services promote attendance and learning at school and can dramatically improve children’s access to WASH. Collecting accurate monitoring data on children in WASH interventions helps agencies in both sectors improve child-sensitive responses to impacts. Supporting caregivers to share the burden of water insecurity reduces time poverty and stress, promoting household well-being. Building equitable and resilient social and systems that support children and caregivers enables them to better navigate the direct and indirect risks associated with water insecurity, which never impacts in isolation from WASH-related health, nutrition, education, or protection systems. Supporting equitable and resilient systems through water-sensitive and child-sensitive planning and investment is critical to building the conditions needed for water insecurity to be safely navigated. In addition to these key components, we highlight the need to better understand children’s experiences of and responses to water insecurity, especially in relation to their school participation, psychosocial stress, and health outcomes. Globally, progress towards universal safe access to water is hindered by neglect of children in WASH service design, delivery, and monitoring. We need to improve WASH responses for children.
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1. Nounkeu C, Kamgno J, Dharod J. Assessment of the relationship between water insecurity, hygiene practices, and incidence of diarrhea among children from rural households of the Menoua Division, West Cameroon. 2019. ncbi.nlm.nih.gov
2. Okafor CO, Ude UI, Okoh FN, Eromonsele BO. Safe drinking water: The need and challenges in developing countries. InWater quality-new perspectives 2024 Jan 24. IntechOpen. intechopen.com
3. Health Organization W. State of the world's drinking water: an urgent call to action to accelerate progress on ensuring safe drinking water for all. 2022. google.com
4. Reader GT. Access to drinking water, food security and adequate housing: challenges for engineering, past, present and future. Symposium on responsible engineering and living. 2022. [HTML]
5. Hope R. Four billion people lack safe water. Science. 2024. [HTML]
6. Ali S. Clean drinking water and future prospective. Pakistan Journal of Science. 2022. paas-pk.org
7. Barrington DJ. Inadequate water, sanitation and hygiene in the South Pacific: how might it be impacting children? 2016. [PDF]
8. E. Cooper-Vince C, Kakuhikire B, Vorechovska D, Q. McDonough A et al. Household water insecurity, missed schooling, and the mediating role of caregiver depression in rural Uganda. 2017. ncbi.nlm.nih.gov
9. Young SL, Bethancourt HJ, Ritter ZR, Frongillo EA. Estimating national, demographic, and socioeconomic disparities in water insecurity experiences in low-income and middle-income countries in 2020–21: a cross-sectional, observational study using nationally representative survey data. The Lancet Planetary Health. 2022 Nov 1;6(11):e880-91. thelancet.com
10. Shah SH, Harris LM, Menghwani V, Stoler J, Brewis A, Miller JD, Workman CL, Adams EA, Pearson AL, Hagaman A, Wutich A. Variations in household water affordability and water insecurity: An intersectional perspective from 18 low-and middle-income countries. Environment and Planning F. 2023 Sep;2(3):369-98. sagepub.com
11. Kimutai JJ, Lund C, Moturi WN, Shewangizaw S, Feyasa M, Hanlon C. Evidence on the links between water insecurity, inadequate sanitation and mental health: A systematic review and meta-analysis. Plos one. 2023 May 25;18(5):e0286146. plos.org
12. Ahmad S, Zahra J, Ali M, Ali S, Iqbal S, Kamal S, Tahir M, Aborode AT. Impact of water insecurity amidst endemic and pandemic in Pakistan: Two tales unsolved. Annals of Medicine and Surgery. 2022 Sep 1;81. nih.gov
13. Khalil S, Bader Sheikh S, Jamal U, Khan HF. Household water insecurities and willingness to pay in Karachi. Water Policy. 2023. iwaponline.com
14. Patrick E, Butsic V, Potts MD. Assessing land use change trajectories following food insecurity shocks in 25 low-and middle-income countries. Global environmental change. 2025. sciencedirect.com
15. Rhue SJ, Torrico G, Amuzie C, Collins SM, Lemaitre A, Workman CL, Rosinger AY, Pearson AL, Piperata BA, Wutich A, Brewis A. The effects of household water insecurity on child health and well‐being. Wiley Interdisciplinary Reviews: Water. 2023 Nov;10(6):e1666. wiley.com
16. Gyan KA, Duan H. Impact of Water Scarcity on Education Outcomes: Evidence from 26 African Countries. Journal of the Knowledge Economy. 2025. [HTML]
17. Ezennia J, Schmidt LA, Ritchie LD, Blacker L, McCulloch CE, Patel AI. Water security experiences and water intake among elementary students at low-income schools: A cross-sectional study. Academic pediatrics. 2023 Jan 1;23(1):68-75. sciencedirect.com
18. FitzGerald SOD. Water Insecurity in K-12 Schools in the US: Understanding State Laws, Drinking Water Violations, and Lived Experiences. 2024. olemiss.edu
19. Martey E, Asante BO, Prah S, Etwire PM. Access to dry season community water resources and children's school attendance and work: Evidence from Ghana. International Journal of Educational Development. 2025 Oct 1;118:103401. [HTML]
20. Eshun EC. Beyond the Household: Embodied Experiences and Well-Being Implications of Water Insecurity in an Urban Ghanaian Girls' Boarding School. 2023. ohiolink.edu
21. Izah SC, Ogwu MC. Water Scarcity and Insecurity: Causes and Consequences. InWater Quality and Safety in the Global South: Challenges, Solutions and Future Directions 2026 Jan 10 (pp. 1-24). Cham: Springer Nature Switzerland. [HTML]
22. Brewis A, DuBois LZ, Wutich A, Adams EA, Dickin S, Elliott SJ, Empinotti VL, Harris LM, Ilboudo Nébié E, Korzenevica M. Gender identities, water insecurity, and risk: Re‐theorizing the connections for a gender‐inclusive toolkit for water insecurity research. Wiley Interdisciplinary Reviews: Water. 2024 Mar;11(2):e1685. nsf.gov
23. Olatoye TA, Fru RN. Water security and livelihoods in the arid zones of South Africa: A human geography approach to rural education and curriculum development. Frontiers in Education. 2025. frontiersin.org
24. Gu W, Qin Y. Targeted opportunities to mitigate water scarcity, inequality, and inequity embedded in international food trade for vulnerable countries. Water Research. 2024. [HTML]
25. Humphreys KL, King LS, Guyon-Harris KL, Zeanah CH. Caregiver regulation: A modifiable target promoting resilience to early adverse experiences. Psychological trauma: theory, research, practice, and policy. 2022 Apr;14(S1):S63. apa.org
26. Szlamka Z, Hanlon C, Tekola B, Pacione L, Salomone E, WHO CST Team, Servili C, Hoekstra RA. Exploring contextual adaptations in caregiver interventions for families raising children with developmental disabilities. Plos one. 2022 Sep 28;17(9):e0272077. plos.org
27. Wong PW, Lam YY, Lau JS, Fok HK, WHO CST Team Servili Chiara 4 Salomone Erica 5 6 Pacione Laura 4 5 Shire Stephanie 6 Brown Felicity 7 8. Adapting and pretesting the World Health Organization’s Caregiver Skills Training Program for children with autism and developmental disorders or delays in Hong Kong. Scientific Reports. 2022 Oct 8;12(1):16932. nature.com
28. Sundberg F, DeBeaufort C, Krogvold L, Patton S, Piloya T, Smart C, Van Name M, Weissberg‐Benchell J, Silva J, A diMeglio L. ISPAD clinical practice consensus guidelines 2022: managing diabetes in preschoolers. Pediatric Diabetes. 2022 Dec 20;23(8):1496. nih.gov
29. Chaudhary N, Swanepoel A. Editorial Perspective: What can we learn from hunter‐gatherers about children's mental health? An evolutionary perspective. Journal of Child Psychology and Psychiatry. 2023 Oct;64(10):1522-5. wiley.com
30. Psaki S, Haberland N, Mensch B, Woyczynski L, Chuang E. Policies and interventions to remove gender‐related barriers to girls' school participation and learning in low‐and middle‐income countries: A systematic review of the evidence. Campbell Systematic Reviews. 2022 Mar;18(1):e1207. wiley.com
31. Adane Y, Ambelu A, Yenesew MA, Mekonnen Y, Kassahun T. Effect of menstruation on school attendance of girls along with water, sanitation, and hygiene services in Northwest Ethiopia. The Pan African Medical Journal. 2025 Jan 16;50:28. nih.gov
32. Kangmennaang J, Bisung E, J. Elliott S. ‘We Are Drinking Diseases’: Perception of Water Insecurity and Emotional Distress in Urban Slums in Accra, Ghana. 2020. ncbi.nlm.nih.gov
33. Azupogo UW, Achore M, Dery FA, Bisung E. Health implications of coping with water insecurity at the household level. Water Security. 2023. [HTML]
34. Rosinger AY. Water needs, water insecurity, and human biology. Annual Review of Anthropology. 2023. annualreviews.org
35. Parker SY, Parchment KF, Gordon-Strachan GM. The burden of water insecurity: a review of the challenges to water resource management and connected health risks associated with water stress in small island developing states. Journal of Water and Climate Change. 2023 Dec 1;14(12):4404-23. iwaponline.com
36. Hasan MM, Habib A, Alam MJ, Islam S et al. Industrial applications, environmental fate, human exposure, and health effects of PFAS. Pollutants. 2025. mdpi.com
37. Thakur R, Joshi V, Sahoo GC, Jindal N, Tiwari RR, Rana S. Review of mechanisms and impacts of nanoplastic toxicity in aquatic organisms and potential impacts on human health. Toxicology Reports. 2025 Jun 1;14:102013. sciencedirect.com
38. Butzin-Dozier Z, N. Mertens A, T. Tan S, A. Granger D et al. Stress Biomarkers and Child Development in Young Children in Bangladesh. 2023. ncbi.nlm.nih.gov
39. Gaffan N, Kpozehouen A, Degbey C, Ahanhanzo YG, Paraïso MN. Effects of household access to water, sanitation, and hygiene services on under-five mortality in Sub-Saharan Africa. Frontiers in Public Health. 2023 Apr 27;11:1136299. frontiersin.org
40. Health Organization W. State of the world's drinking water: an urgent call to action to accelerate progress on ensuring safe drinking water for all. 2022. google.com
41. Gaffan N, Kpozèhouen A, Dégbey C, Glele Ahanhanzo Y, Glele Kakai R, Salamon R. Household access to basic drinking water, sanitation and hygiene facilities: secondary analysis of data from the demographic and health survey V, 2017–2018. BMC Public Health. 2022 Jul 14;22(1):1345. springer.com
42. Khilchevskyi V, Karamushka V. Global water resources: distribution and demand. Clean water and sanitation. 2022. [HTML]
43. Brown J, Acey CS, Anthonj C, Barrington DJ, Beal CD, Capone D, Cumming O, Fedinick KP, Gibson JM, Hicks B, Kozubik M. The effects of racism, social exclusion, and discrimination on achieving universal safe water and sanitation in high-income countries. The Lancet Global Health. 2023 Apr 1;11(4):e606-14. thelancet.com
44. Tinazzi I. Water scarcity, migrations and climate change: an assessement of their nexus. 2024. unive.it
45. Collins SM. What are we missing when we measure water insecurity?. 2023. [HTML]
46. Lwandiko M. Health Water Scarcity: A Deadly Problem to Children. Available at SSRN 4818236. 2024. ssrn.com
47. Jahura S, Islam MS, Mostafa MG. Impact of water scarcity on rural livelihood in the drought-prone region: A review of global perspectives. Indonesian Journal of Social Science. 2024 Jan 1;16(1). researchgate.net
48. David O, Hughes S. Whose water crisis? How policy responses to acute environmental change widen inequality. Policy Studies Journal. 2024. wiley.com
49. Rad J. Health inequities: a persistent global challenge from past to future. International journal for equity in health. 2025. springer.com
50. Rusca M. Water inequalities. Routledge handbook of water and development. 2023. [HTML]
51. Wright CY, Kapwata T, Cook C, Howard SJ, Makaula H, Merkley R, Mshudulu M, Tshetu N, Naidoo N, Scerif G, Draper CE. Inadequate access to potable water impacts early childhood development in low-income areas in Cape Town, South Africa. Annals of global health. 2023 Nov 24;89(1):82. nih.gov
52. Adams EA, Byrns S, Kumwenda S, Quilliam R, Mkandawire T, Price H. Water journeys: Household water insecurity, health risks, and embodiment in slums and informal settlements. Social Science & Medicine. 2022 Nov 1;313:115394. sciencedirect.com
53. Ilahy AD, Kaaffah MS, Latipah E, Har AA, Bestari D. Developmental Psychology of Learners: Environmental Factors Influencing Child Development. Linguanusa: Social Humanities, Education and Linguistic. 2025 Nov 20;3(2):98-114. [HTML]
54. Mousavi SZ, Gharibzadeh S. Growing up in a challenging environment: A cultural analysis of self-regulation development in poverty. European Journal of Developmental …. 2022. [HTML]
55. Bao K, Zhang X, Cai L. The closed loop between parental upbringing and online game addiction: a narrative study of rural children’s growth in China. Psychology Research and Behavior Management. 2024 Dec 31:1703-16. tandfonline.com
56. Islam MZ, Dhanekula A. Measuring the Security Impact of Zero Trust Access Controls: A Mixed-Methods Study of Identity-Based Policies (Cisco ISE+ AD) and Incident Reduction. American Journal of Data Science and Analytics. 2023 Jun 28;4(06):01-42. ajdsa-journal.org
57. Chen O, Paas F, Sweller J. A cognitive load theory approach to defining and measuring task complexity through element interactivity. Educational Psychology Review. 2023. springer.com
58. Riquelme-Arredondo A, Torres-Contreras H, Quiroz V, Gutiérrez-Martinetti S. Let's take care of the water: Social representations in preschoolers. International Journal of Early Childhood. 2025 Apr;57(1):231-54. [HTML]
59. Rasmussen AB, Schmidt CH. Access to children's perspectives?. Social Sciences. 2024. mdpi.com
60. Gans KM, Chacón V, Warykas SW, Baird M, Esquivel V, Zhang S, Tovar A, Ray S, Inman N, McCauley P, Zambrano Rodriguez VC. Exploring barriers and facilitators to water availability and accessibility, and potential strategies for improving water accessibility and children’s intake in family childcare homes: a qualitative study. Frontiers in Nutrition. 2025 Mar 12;12:1442070. frontiersin.org
61. L. Sprague N, M. Zonnevylle H, Jackson Hall L, Williams R et al. Environmental health perceptions of urban youth from low‐income communities: A qualitative photovoice study and framework. 2023. ncbi.nlm.nih.gov
62. B. Fisher C. Privacy and Ethics in Pediatric Environmental Health Research—Part I: Genetic and Prenatal Testing. 2006. ncbi.nlm.nih.gov
63. Health Organization W. Global climate change and child health: training for health care providers. 2023. who.int