Wetlands are critical natural resources in developing countries where they perform a range of environmental functions and provide numerous socio-economic benefits to local communities and a wider population. In recent years, however, many wetlands throughout eastern Africa have come under extreme pressure as government policies, socio-economic change and population pressure have stimulated a need for more agriculturally productive land. Although wetland drainage and cultivation can make a key contribution to food and livelihood security in the short term, in the long term there are concerns over the sustainability of this utilization and the maintenance of wetland benefits. This article draws upon recent research carried out in western Ethiopia, which addressed the sustainability of wetland agriculture in an area of increasing food insecurity and population pressure. It discusses the impacts of drainage and cultivation on wetland hydrology and draws attention to local wetland management strategies, particularly those characterized by multiple use of wetlands, where agriculture exists alongside other wetland uses. The article suggests that where multiple wetland uses exist, a range of benefits can be sustained with little evidence of environmental degradation. Ways of promoting and empowering such sustainable wetland management systems are discussed in the context of the wider need for water security throughout the region.