Deteriorating surface water quality from poor sewage disposal, and lack of alternative water sources have resulted in partially diluted and sometimes untreated wastewater being used for local irrigation in urban, peri-urban and even rural agriculture by the poor. Un(der)employment, and a demand for fresh perishable food products by city dwellers are other drivers of this practice. Scenarios typical of conditions in poor countries are presented through case studies focusing more specifically on India, Pakistan, Vietnam, and Ghana. These emphasize water and nutrient value and the necessity for conjunctive use. Year round availability that allows for multiple cultivation cycles results in a different cropping pattern to regular water use. Earnings from wastewater agriculture lift farmers out of poverty. Farming also ensures food security for the poorer households. Countering these benefits are health risks to farmers and consumers from helminth infections in particular. The current situation of wastewater agriculture requires immediate solutions. The policy implications of applying wastewater use guidelines in resource-poor situations are analyzed and short-term alternative management responses are presented. In conclusion the potential for land application of wastewater as a possible lower-cost solution which will simultaneously improve environmental sanitation and downstream water quality is briefly discussed.
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