This article presents the results of empirical research conducted in Central Vietnam in 2016 into water, sanitation, and hygiene (WASH) initiatives. It uncovered changes in gender relations and power dynamics at both household and community levels, aiming to explore the extent to which both practical and strategic interests of women can be influenced and changed by WASH policies and programming. In particular, we were interested in assessing the impact of a Gender and WASH Monitoring Tool (GWMT), developed by Plan International Australia and Plan Vietnam, on women’s strategic gender needs. In this article, we discuss the types of changes reported by women and men of different ages and ethnicities and the reasons for their occurrence. There were a wide range of reported reasons for change, with implications for our understanding of the relationship between changes in gender relations at the household and community levels. We also consider the relationship between wider shifts in social norms in the context of rural Vietnam. The Vietnam research highlights the roles that WASH initiatives can play in furthering strategic gender needs and hence promoting gender equality and women’s empowerment. It also shows the importance of addressing Sustainable Development Goal (SDG) 5 (on gender equality) and SDG 6 (on water and sanitation) together.