With an increasing population and rapid development of the economy and society of the Yellow River Basin region, the Yellow River is at crisis point. The discrepancy between supply and demand of water resources is a key issue. In 2000-2006, the mean annual discharge of the Yellow River entering the delta was 13.2 billion m3, a reduction of 18.6 billion m3 compared with the 1980s, and 9 billion m3 less than in the 1990s. The water requirements of various sectors are increasing. Large amounts of water essential to maintain the health of the delta ecosystem have been diverted for other users. The lower river channel is shrinking and the threat of flooding is becoming severe. Moreover, water pollution is increasing to a serious level; the river mouth ecosystem is subject to degradation. Due to overall decreased flow into the delta, and almost no flow into the delta for much of the year except in wet periods, biodiversity is threatened and there has been degradation of the ecological environment. In view of the water scarcity and variation in water supply, particularly in the context of climate change, measures need to be taken to realise sustainable water use in the Yellow River Delta region. In view of the lack of a complete index system for sustainable utilisation of regional water resources in China, this paper examines the major countermeasures for sustainable water use in the region. A rational adjustment mechanism for water prices is needed. Adjustment of agricultural infrastructure and water saving need to be directed by water prices, and thus the reasonable exploitation of groundwater must also be directed by water prices. Participation of the public is to be encouraged, with the development of a water user association that will become involved in formulating water rights, water allocation and water prices. Decision-making, management and supervision of this association will be done in a democratic way to promote the social management of water saving. © 2011 Taylor & Francis.