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This study investigated the effect of providing extra water and nesting material to Moo Lath sows on piglet survival and growth. Three treatments were evaluated in a randomized block design with six sows/treatment. In the Control treatment, sows were not provided with nesting material or extra water apart from that included in the feed (conventional smallholder practice). In treatment NM, nesting material was provided 1-2 days before expected farrowing. In treatment NMW, nesting material as in NM and extra water were provided ad libitum throughout the study. Data on sow feed and water intake, plasma protein concentration (TPP), body weight, and re-mating period, and on litter size, body weight, and survival of piglets, were collected for two reproduction cycles. NMW sows had higher water intake than Control and NM sows (14.7, 4.5, and 4.5 L/day, respectively, SE = 0.2). The weight loss from 2 weeks prior to farrowing until weaning was smaller in NMW than in NM and Control sows (16.0, 23.8, and 22.9 kg, respectively, SE = 0.9). TPP dropped from farrowing until 21 days of lactation in NMW sows, whereas it increased or was unchanged in NM and Control sows. The re-mating period was shorter and the number of litters/year was higher in NMW than in Control and NM sows (2.2, 2.0, and 2.0, respectively, SE = 0.01). Piglet mortality was lower in NMW than in Control and NM (9.5, 43.9, and 26.7%, respectively, SE = 4.9). Piglets in NMW were heavier at weaning and had higher daily weight gain than Control and NM piglets. It was concluded that providing water ad libitum and nesting material improved piglet survival and growth, and that providing water ad libitum improved sow physiological and reproductive fitness. However, provision of nesting material without access to ad libitum water might increase susceptibility to heat stress in sows.