India’s water bodies are rife with pollution from indiscriminate disposal of untreated sewage and septage, endangering the lives of millions of people depending directly or indirectly on these rivers. According to the estimates of the National Green Tribunal vide order no.673/2018, more than 60 percent of sewerage generated by urban India is not treated. “Composite Water Management Index”, a report released by NITI Aayog (2018), pronounced that India is suffering “the worst water crisis in history’’ – underscoring the importance of instituting measures to abate river water pollution. The urban population grew to 377.1 million in 2011 from 286.1 million in 2001, according to census data; however, the rapid pace of urbanisation in the country has far outpaced the provisioning of sanitation infrastructure and services in Indian cities. The sanitation policy ecosystem in India has evolved over the years with Faecal Sludge Management emerging as a viable solution and alternative to the conventional networked-based centralised sewer systems. Since there is an urgent need for sanitation-related interventions to abate river pollution, this requires systematic and in-depth study of the issues at play. Therefore, the objectives of this study are threefold – a) it maps out the acts, policies, environmental norms, and water quality indicators pertaining to river and groundwater pollution in India; b) it seeks to establish the relationship between pollution in river and groundwater with urbanisation levels and sanitation infrastructure; and c) it details out recommendations for river water pollution abatement.