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Abstract Water insecurity—the lack of access to sufficient, safe water to meet all household needs—is an escalating challenge in all world regions. It is also associated with unfavorable mental health outcomes, like anxiety and depression. Often situated in the context of drought or general water scarcity, connections between water and mental health often manifest out of the unique characteristics of water—as an important economic and household resource, and one managed primarily by women. This article identifies recognized and theorized pathways between water insecurity and common mental health conditions, as mediated by broader socioeconomic systems in which households are embedded. To this end, we synthesize and connect different literature sets, including limited economic studies in a resource insecurity framework and a small but authoritative body of ethnographic literature. Our review identifies multiple proximate candidate pathways connecting water insecurity with mental health outcomes including community conflicts and/or perceived injustice around water sharing and upkeep, agricultural decline and unemployment, food insecurity or distress migration, decreased water intake, non-exposure to blue spaces, and stress around water management. The gendered role of water management is an overlapping theme across pathways, exposing women disproportionately to forms of conflict, violence, and injustice associated with the risk of common mental illness. In general, there are varied forms of marginalization that people experience within water-insecure contexts. Greater engagement between economics and other disciplines can lend additional theoretical pathways to empirically test the water and mental health connections, associated with people’s water insecurity experiences. 

Abstract Household water management is often women's responsibility, as related to the gendered nature of household roles. Ethnographic data suggest that household water insecurity could increase women's exposure to emotional and physical forms of intimate partner violence (IPV), as punishments for failures to complete socially expected household tasks that rely on water (like cooking and cleaning) and the generally elevated emotional state of household members dealing with resource scarcity. Here, we test the associations between sub-optimal household water access and women's exposure to IPV, using the nationally-representative data from Nepal Demographic and Health Survey, 2016. Drawing upon the intra-household bargaining model as the theoretical framework, we run instrumental variable probit regression, to test the association between household water access and prevalence of IPV against women. After controlling for other known covariates of IPV such as women's empowerment and education, the findings substantiate that worse household water access consistently elevates women's exposures to all forms of IPV. This suggests that improvements in household water access may have additional ramifications for reducing women's risk of IPV, beyond currently recognized socioeconomic benefits. While both household water access and IPV have known health consequences, linking them provides another pathway through which water could affect women's health.