# Silent Scars in the Water–Energy–Food Nexus: How Resource Insecurity Shapes Women’s Mental and Reproductive Health in South Africa

## TL;DR

This study explores how water, energy, and food scarcity in South Africa affect women's mental and reproductive health, linking these issues to broader social and historical inequalities.

## Contribution

The study introduces embodied and emotional dimensions to the Water–Energy–Food nexus framework, emphasizing gendered impacts of resource insecurity.

## Key findings

- Chronic resource insecurity in South Africa is linked to psychological distress and reproductive vulnerability among women.
- Women's coping strategies, such as informal work and transactional sex, partially mitigate but cannot fully address systemic harms.
- The study connects historical neglect from colonial and apartheid eras to current health and social inequities.

## Abstract

Public health relevance—How does this work relate to a public health issue?
This study shows how water, energy, and food scarcity directly shape women’s mental and reproductive health in South Africa.It highlights the links between resource insecurity, intimate partner violence, unsafe abortion, menstrual health challenges, and psychological distress.

This study shows how water, energy, and food scarcity directly shape women’s mental and reproductive health in South Africa.

It highlights the links between resource insecurity, intimate partner violence, unsafe abortion, menstrual health challenges, and psychological distress.

Public health significance—Why is this work of significance to public health?
The findings demonstrate that the Water–Energy–Food nexus is a determinant of health, not only an environmental or technical concern.The study provides rare qualitative evidence on embodied and emotional impacts of scarcity, addressing a critical gap in WEF, gender, and health research.

The findings demonstrate that the Water–Energy–Food nexus is a determinant of health, not only an environmental or technical concern.

The study provides rare qualitative evidence on embodied and emotional impacts of scarcity, addressing a critical gap in WEF, gender, and health research.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?
Integrated policies must link water, energy, and food provision with reproductive health, mental health, gender-based violence protection, and social support.Addressing scarcity requires gender-responsive, rights-based approaches that protect reproductive autonomy, reduce survival sex, and build structural care systems.

Integrated policies must link water, energy, and food provision with reproductive health, mental health, gender-based violence protection, and social support.

Addressing scarcity requires gender-responsive, rights-based approaches that protect reproductive autonomy, reduce survival sex, and build structural care systems.

Women in resource-scarce communities navigate daily scarcity, structural neglect, and gendered violence, leaving profound but often invisible impacts on mental and reproductive health. Women play an active role in the Water–Energy–Food (WEF) space; they provide water, food, and household security daily. This study investigates how chronic deprivation across the WEF nexus shapes experiences of psychological distress, reproductive vulnerability, and social marginalization in South African settings: Lorentzville, a migrant urban informal settlement, and Mqanduli, a peri-urban Eastern Cape community. Using ethnographic methods, including in-depth interviews, focus group discussions, and participatory observation, and an analytical framework combining structural violence and feminist political ecology, we show that insecurity over water, energy, and food constrains reproductive autonomy, amplifies self-reported symptoms of anxiety and depression, and drives coping and adaptation strategies such as informal work, transactional sex, and fragile social support networks. These strategies, while mitigating immediate risks, cannot fully offset systemic harms. By foregrounding women’s lived experiences, this study extends the WEF nexus framework to include embodied, emotional, and reproductive dimensions, linking historical legacies of colonial and apartheid neglect to contemporary inequities. The findings offer critical insights for integrated health, social, and resource policy interventions that center on gender, care, and justice within environmental, wellbeing, and livelihood.