More than a third of humanity lives in regions with less than 1 million liters of fresh water per person per year. Population growth will increase water demand while climate change in arid and semi-arid areas may reduce water availability. The Murray-Darling Basin in Australia is a region where water reform and planning have been used to reduce consumptive extraction to better sustain river ecosystems under climate variability. Using actual data and previously published models that account for climate variability and climate change, the trade-off between water extractions and water essential to the long-term ecological function of river systems is analysed. The findings indicate that better water planning and a more complete understanding of the effects of irrigation on regional climate evapotranspiration could: (1) increase the overall benefits of consumptive and non-consumptive water use; (2) improve riparian environments under climate variability; and (3) be achieved with only small effects on the profits and gross value of food and fiber production.