This chapter focuses on how water-related uncertainties affect efforts to meet global food demand and nutrition security, and suggests that a shift in the water management paradigm, together with alternative approaches to reducing risk, increasing resilience and improving food security. It addresses water management challenges across scales: namely, from global to farms and crops. The chapter describes the potential for reform in the processing and preparation stages and issues concerning managing water quality and wastewater. Some efforts submitted under the Paris Climate Agreement, such as expanded use of biofuels as a renewable energy source, could substantially increase agricultural water use. Local organizations of farmers and water users are crucial for the adaptive management of water resources and related ecosystems. Examples include local watershed management organizations, fishing associations, farmer field schools, and water user groups. Collective action is a common ecosystem approach around water management, but also for common grazing lands or community forests.