[Objective]The middle reaches of the Yangtze River serve as a crucial support for ecological preservation and economic development within the Yangtze River basin. Despite its abundant water resources, issues concerning water resource consumption remain significant. [Methods]This study focuses on the provinces of Hubei, Hunan, and Jiangxi in the middle reaches of the Yangtze River, analyzing data from 2011 to 2021. Employing the water resource ecological footprint model, the research conducts a temporal and spatial analysis of ecological footprints and related indicators in these regions. Furthermore, utilizing the Pressure-State-Response (PSR) framework and ecological footprint indicators, an evaluation index system for sustainable water resource utilization in the middle reaches of the Yangtze River is constructed. The study calculates pressure indices, state indices, response indices and comprehensive indices for the three provinces. [Results](1)Per capita water resources ecological footprints and carrying capacity in the three provinces show an overall increasing trend, with the carrying capacity exceeding the ecological footprint, leading to an ecological surplus. This indicates a generally favorable water resources ecological status in the provinces. Jiangxi province exhibits the highest per capita water resources ecological surplus ranging between 3.186 and 7.966, while Hubei province records the lowest ranging from 0.304 to 2.603. (2)Production water holds the largest share in the water accounts of the ecological footprints in all three provinces, followed by domestic water. Although environmental water accounts for the smallest share, it exhibits the most significant increase. Notably, Hubei province shows a substantial increase in per capita environmental water footprint, rising from 0.1% in 2011 to 17% in 2021. (3)The water resources ecological footprint per 10,000 GDP demonstrates a notable declining trend, indicating an enhancement in water resources utilization efficiency. Jiangxi province displays the highest water resources ecological footprint per 10,000 GDP, while Hubei province exhibits the lowest. Nonetheless, the gap between them is gradually narrowing each year.(4)The pressure index, state index, and response index in the three provinces generally depict decreasing, increasing, and increasing trends, respectively. The decline in the pressure index is more pronounced, while the rise in the other indices is limited. The comprehensive index for all three provinces fluctuates with an upward tendency. Although stable overall, the provinces exhibit minor discrepancies in their indices. However, none have surpassed the historical best levels. [Conclusion]The overall sustainability level of water resources utilization in the three provinces remains stable, with significant room for improvement. Continued efforts are necessary to enhance the production and domestic water, promote the ecological water, and advance measures for sustainable water resources utilization. These steps aim to elevate the level of sustainable water resource utilization. The findings of this study can serve as a reference for decision-making regarding water resources sustainability in the middle reaches of the Yangtze River and other provinces, cities, urban clusters, or basin areas.