Introduction

1.1       Background

Globally, Pakistan is one of those countries facing water scarcity, health and social problems associated with this crisis. In 1947, when the country came into being, water availability was 5650 cubic meters per capita, gradually decreasing. Now Pakistan ranks 14th in the world’s most water-scarce 17 countries. Currently, if we look at the severity of water crises, 2 billion people face high water stress globally, while the number of people facing severe scarcity is 4 billion globally, while Pakistanis are also facing challenging conditions (Global Water Institute, 2023). These challenging conditions can be gauged by the fact that 40% of hospitalized patients are suffering from waterborne diseases, and more tragically, 50% of deaths caused by water diseases are children under the age of 5 years (Bashir et al., 2021).

In Punjab, water scarcity implications are not only causing environmental hazards but also contamination, causing economic and severe public health issues. Evidence suggests that Punjab is facing acute problems in providing safe and drinkable water to its urban and rural populations. The water resources are depleted due to unrestricted extraction and contamination. This situation requires rethinking water management policies and practices (Smith et al., 2020; Khan, 2021).

If we look at the water pollution and contamination levels, we see variation between areas and different districts of the province. In some areas, water is even undrinkable. Water is contaminated with toxic elements, metals, and chemicals in many places, causing many health-related problems (Jamil, 2019). For example, in the district of Lahore, water is being contaminated by industrial waste and unhealthy water treatment facilities, causing many waterborne diseases (Ahmed & Sohail, 2022).

Uncertain water availability patterns also exaggerate the situation due to environmental changes and poor water management policies. The urban population is especially prone to water shortages, consequently relying on expensive and even unhealthy private water supply resources. Similarly, the rural population has indiscriminately restricted access to clean water in all provinces (Rasool et al., 2023).

Low-quality water and an unstable water supply create health issues, especially among children. Punjab is facing the acute problem of malnutrition, which is further exacerbated by  unhealthy  drinking  water,  causing  diarrhea,  a severe hurdle in  the  absorption  of nutrients. According to the World Health Organization, safe water can improve nutritional status and is more critical in areas where water-related problems exist (WHO, 2023).

Studies show water scarcity has substantial effects on children while literature exists about the association between contaminated water and children stunted growth. Research evidence establishes that gastrointestinal diseases from contaminated water impair children’s growth process (Rhue et al., 2023). The MICS (2018) survey revealed many children suffering from malnutrition in Punjab districts which showed low water quality indices.

A complete resolution of these challenges demands detailed knowledge about how the people of different districts utilize their water resources. The research analyzes how poor water leads to health problems and financial burdens across Punjab. The research targets three main objectives to investigate household water demand in Lahore alongside water shortage issues and children’s dietary problems and women’s health effects from water access problems.

These problems drive us in developing objectives which focus on household water demand and child nutritional status and water scarcity alongside the water-related effects on female wellbeing. Additionally, this thesis also addresses water policies, experts’ opinions, and stakeholder concerns in Chapter 5. This chapter provides a broader perspective on the policy framework and governance issues surrounding water management in Punjab.