Cooperation is important in transboundary groundwater management. Actions in the utilization of aquifers on one side of the border can have negative impacts upon a neighboring state’s overall access, and consequently their delivery on national social and gender equity goals. In turn, cooperation on shared groundwater can offset conflicts and enhance joint benefits of the aquifers. International instruments increasingly emphasize gender and social factors, but transboundary arrangements and practices regarding shared aquifers continue to fail to address these issues. This may jeopardize water security and livelihood options for small communities in the border regions, enhancing risks to social cohesions, livelihoods and wellbeing.