Laos is currently promoting hydropower generation and sale of electricity to&nbsp;neighbouring countries as a key economic development strategy. While helping the&nbsp;Government of Laos achieve its economic development goals, hydropower comes with&nbsp;costs that accrue at the local level. Hydropower projects can interrupt, alter and inhibit&nbsp;river flows and associated ecological services that have supported rural livelihoods. The&nbsp;effects of hydropower therefore extend to people living downstream of the dams. Using a&nbsp;replicated cross-sectional case study design, this empirical research identifies and&nbsp;explores the perceived direct and indirect effects hydropower projects have on the people&nbsp;living downstream of six hydropower projects in Laos, which are at different&nbsp;developmental stages─planned, recently commissioned and long term operation. The&nbsp;Sustainable Livelihoods Framework has been employed to categorise and quantify these&nbsp;effects in the environmental, financial, physical, human and social domains. A social&nbsp;survey was implemented using face-to-face interviews of 40 households per case study.Villagers experienced loss of productive land, river ecosystems degradation and decline&nbsp;in river-based fisheries. Some households benefitted from hydropower related&nbsp;employment. However, most jobs were ephemeral and on-going employment was limited,&nbsp;particularly if the project was foreign-owned. Impacts on the natural capital were felt&nbsp;most acutely in villages below recently commissioned dams. Over time, people could&nbsp;adjust and take advantage of any new livelihoods opportunities associated with dams&nbsp;including reservoir-based fisheries and hydropower tourism. When hydropower&nbsp;developers incorporate environmental and social obligations during planning,&nbsp;construction and operation, loss of traditional livelihoods, especially river based fishing,&nbsp;can be reduced while social benefits can be fostered, particularly through livelihood&nbsp;improvement programmes. Human and social capital is improved if developers construct&nbsp;school and health care facilities.Key policy recommendations include mandating the consideration of downstream&nbsp;communities in social impact assessment, that ex-post impact assessments are conducted&nbsp;in addition to the ex-ante impact assessments, that capacity of downstream communities&nbsp;is increased by improving education and training, that mitigation measures are considered&nbsp;and implemented for every dam, that hydropower projects are mandated to provide&nbsp;environmental flows and a land-for-land option is available for compensation