Irrigation barriers fragment aquatic habitats and although implemented mainly to support food production, sometime trade-off against wild food systems like inland fisheries. A demonstrative example is rice field fisheries, which occur when seasonal overbank flooding facilitates wild fish migration into floodplains now occupied by rice fields in southeast Asia's Lower Mekong Basin. These highly productive inland fisheries are central to human dietary health and wellbeing for millions of people including vulnerable and disadvantaged groups at the centre of the United Nations SDGs, such as people living rurally and remotely, subsistence fishers, and they provide nutrients critical to child and maternal health for which there is currently no viable substitute. Fish passage technology like fishways are implemented to reinstate fish migration in the Lower Mekong Basin in agricultural landscapes fragmented by irrigation infrastructure. Implementation is aided by barrier prioritization frameworks which help strategically locate fishways. This study critically evaluated 93 published barrier prioritisation frameworks to explore how they were developed, their relevance for tropical and developing contexts, and how they serve communities depending on fish for nutrition. It demonstrated for the first time that present frameworks are ill-equipped to prioritise barriers to support human nutrition, even where safeguarding productive fisheries for nutrition security motivates fish passage remediation. Floodplains, tropical ecosystems, and developing contexts were underrepresented. These findings prompt deeper reflection of the criteria used to prioritise barriers to fish passage and how prioritisation can better serve local communities.