How intermittent piped water supplies impact households and coping strategies: A systematic review

Abstract More than a billion people globally use a piped water system that is an intermittent water supply (IWS), where water is often unavailable from the network. Previous reviews have summarized relationships between IWS, water quality, human health risks, and coping costs. Yet, beyond these documented impacts, IWS bears additional—often invisible—burdens on users comprising both financial and non-financial costs and social and health burdens. We conducted a systematic review to document these burdens by searching databases for publications that described human impacts of IWS and coping or adaptive management strategies at the household or individual level. We used a novel codebook of coping strategies and adaptive management to synthesize 140 studies meeting our inclusion criteria conducted in 36 countries between 1994-2023. The most frequently reported impacts were increased household spending, poor water quality, time lost managing water, livelihood disruptions, and hygiene/sanitation interruptions. We also found evidence of links between IWS and respiratory infections, vector-borne diseases, dietary changes, physical strain and injuries, dehydration, sleep disruption, psychosocial stress, and interpersonal violence. The most common coping strategies were related to water storage, purchasing, and acquisition costs. Unpredictable IWS was most commonly linked to a small set of household impacts. This review demonstrates that the impacts of IWS on households are more diverse than previously synthesized and highlights the importance of interdisciplinary work to support sustainable solutions that mitigate adverse household impacts of IWS systems.