When Tropical Cyclone Chido tore through northern Mozambique, Massiala Agostinho was eight months pregnant.

The winds damaged homes. Floodwaters swallowed roads. The clinic she planned to deliver in became harder to reach. Clean water, something so ordinary on most days, was suddenly uncertain. Labor does not wait for infrastructure to recover.

Massiala delivered safely, but her story captures a larger truth across East and Southern Africa: water is becoming more volatile, more political, and more unequal.

In some communities, it arrives violently. Rivers burst their banks in Mozambique and South Sudan, cutting off villages and contaminating wells. Roads disappear; health facilities ration water and sanitation systems collapse. Pregnant women calculate whether to risk the journey or wait and hope.

In others, water simply vanishes. In southern Madagascar’s drought-stricken Grand Sud and Zambia’s Western Province, years of failed rains have emptied boreholes and hardened soil into dust. Women walk longer distances under punishing heat. Girls miss school because fetching water takes hours. Families ration what little they collect. Clinics see pregnant women arrive dehydrated, already exhausted before labor begins.

Too much water destroys access. Too little water stretches survival. Across Africa, roughly 400 million people lack access to safely managed drinking water, and more than 800 million lack safely managed sanitation and hygiene services, according to continental water monitoring bodies. The consequences are not abstract. Inadequate water and sanitation cost countries billions annually in lost productivity and health impacts. But the deeper cost is borne quietly, inside households.

Water is time, and time is unequal

Even in years without floods or declared drought, the struggle continues. In rural communities across the region, girls still rise before sunrise to fetch water from rivers or distant wells before school. Some arrive late and some drop out entirely, and the yellow jerrycan remains part of their daily lives.

Water is also about dignity 

Without safe, private sanitation facilities and reliable clean water, managing menstruation becomes a monthly negotiation with shame and risk. For adolescent girls, the absence of WASH infrastructure can mean missing several days of school each month. For displaced women in flood-affected areas, it can mean queuing in unsafe spaces after dark.

Water is also health

A clinic without reliable clean water cannot guarantee safe childbirth. Infection prevention becomes harder and hygiene becomes fragile. In flood-affected areas, contaminated water increases the risk of disease outbreaks just as communities are struggling to recover. In drought-affected zones, water scarcity reduces sanitation standards and strains already limited services.

The paradox is striking, water is life, and yet its instability is reshaping lives in deeply unequal ways. Climate change is also intensifying this volatility. The Horn of Africa has endured historic droughts, while Southern Africa faces increasingly severe storms and cyclones. Communities that contributed least to global emissions are navigating the harshest consequences with women and girls absorbing the impact first.

This urgency is now recognized at the highest political level. The African Union has declared 2026 the Year of “Assuring Sustainable Water Availability and Safe Sanitation Systems to Achieve the Goals of Agenda 2063,” acknowledging that water security is foundational to health, education, gender equality and economic resilience across the continent.

When roads are cut off by floods, it is women, late into their pregnancies, who feel the distance most sharply. When wells run dry, it is girls whose education shrinks. When sanitation systems fail, it is women’s safety and dignity that erode.

This is not only an environmental issue, but also a development, gender equality and health systems issue. The future of East and Southern Africa will not be decided by rainfall alone. It will be shaped by whether water systems are built to withstand extremes, whether clinics are designed with resilience in mind, whether boreholes endure prolonged drought, whether sanitation infrastructure survives floods, and whether water access is treated as foundational to education and maternal health rather than as an afterthought.

Massiala’s daughter was born into a world where storms are stronger and dry seasons are longer. The question is whether the systems around her will be stronger too. Because in this region, water is no longer a background condition. It is the story of too much, too little, and still too unequal.

UNFPA is the United Nations sexual and reproductive health agency, working to uphold the rights and choices of women, girls and young people across more than 150 countries. Through our work, we ensure that every pregnancy is wanted, every childbirth is safe, and every young person can fulfil their potential.