This paper assesses the sustainability, efficiency and equity of water use in Latin America and the Caribbean (LAC) by means of a geographic Water Footprint Assessment (WFA). It aims to provide understanding of water use from both a production and consumption point of view. The study identifies priority basins and areas from the perspectives of blue water scarcity, water pollution and deforestation. Wheat, fodder crops and sugarcane are identified as priority products related to blue water scarcity. The domestic sector is the priority sector regarding water pollution from nitrogen. Soybean and pasture are priority products related to deforestation. We estimate that consumptive water use in crop production could be reduced by 37% and nitrogen-related water pollution by 44% if water footprints were reduced to certain specified benchmark levels. The average WF per consumer in the region is 28% larger than the global average and varies greatly, from 912 m3/year per capita in Nicaragua to 3468 m3/year in Bolivia. Ironically, the LAC region shows significant levels of undernourishment, although there is abundant water and food production in the region and substantial use of land and water for producing export crops like soybean.