Climate‐Induced Water Insecurity and the Physical Health of Women and Girls in Sub‐Saharan Africa

Climate change and climate variability are intensifying water insecurity across Sub‐Saharan Africa, but the health burden is mediated by infrastructure, affordability, social inequality, and the gendered organization of water work. This scoping review maps evidence on how climate‐related water insecurity affects the physical health of women and girls and identifies where intervention and measurement should move next. The search identified 1146 records; 32 met the initial eligibility criteria, and an updated search with targeted backward and forward citation chaining identified 13 additional eligible sources, producing a final synthesis of 45 studies and reports. The evidence is strongest for musculoskeletal pain, fatigue, injury, and physical exhaustion associated with water collection. It also identifies important pathways through constrained hygiene and menstrual care, sexual and gender‐based violence, transactional sex and exploitation, reproductive and maternal vulnerability, and HIV‐related health. Mental distress and depression are treated as interacting, cross‐cutting outcomes rather than the primary endpoint. Climate hazards are important drivers, but water insecurity is also produced by service failure, poverty, governance deficits, conflict, urbanization, contamination, and affordability constraints. The review argues that evidence is already sufficient to justify action: priorities are reliable and closer water services, safe access, gender‐ and age‐disaggregated monitoring using experiential measures such as IWISE/HWISE, and intervention evaluations that measure bodily, reproductive, safety, and psychosocial outcomes. Future research should be targeted toward causal pathways and intervention effectiveness rather than repeating descriptive accounts of burden.