Reducing nutrient discharge from wastewater is essential to mitigating aquatic eutrophication; however, energy- and chemicals-intensive nutrient removal processes, accompanied with the emissions of airborne contaminants, can create other, unexpected, environmental consequences. Implementing mitigation strategies requires a complete understanding of the effects of nutrient control practices, given spatial and temporal variations. Here we simulate the environmental impacts of reducing nutrient discharge from domestic wastewater in 173 countries during 1990–2050. We find that improvements in wastewater infrastructure achieve a large-scale decline in nutrient input to surface waters, but this is causing detrimental effects on the atmosphere and the broader environment. Population size and dietary protein intake have the most significant effects over all the impacts arising from reduction of wastewater nutrients. Wastewater-related impact hotspots are also shifting from Asia to Africa, suggesting a need for interventions in such countries, mostly with growing populations, rising dietary intake, rapid urbanisation, and inadequate sanitation.