<p>The Indo-Gangetic Plain (IGP), a densely populated (&gt; 1000 people/km²) and agronomically rich region, is heavily reliant on groundwater for agriculture and drinking water. However, unsustainable extraction in India alone, estimated at ~ 245 billion m³ annually, surpassing USA and China combined, has aggravated both aquifer depletion and arsenic (As) contamination in the Gangetic delta, posing serious health risks. Despite extensive documentation over the past three decades, critical knowledge gaps remain: (i) synergies between irrigation practices, soil biogeochemistry, and aquifer recharge; (ii) socio-economic barriers to adopt mitigation technologies (e.g., safe well identification, managed aquifer recharge, alternate wetting and drying); and (iii) the lack of integrated policies linking water governance with public health and agricultural sustainability. This review presents a comprehensive, interdisciplinary synthesis connecting groundwater over-extraction dynamics with arsenic geochemistry, mobilization and evidence-based mitigation by integrating bibliometric assessment of 1,850 + publications (1989–2025) identifying research trends and knowledge gaps, hydrogeochemical datasets revealing mechanistic arsenic distribution, and welfare cost evaluations linked to arsenic exposure. The synthesis examines: (1) different drivers of aquifer depletion as well as arsenic mobilisation processes in groundwater; (2) sustainable management of groundwater by government bodies and independent researchers through drinking water arsenic mitigation strategies and alternate rice production strategies; and (3) stakeholders’ perspectives on the socio-economics of groundwater management. By merging hydrogeochemical science with agricultural innovation, socio-economic analysis, and governance perspectives, this review provides integrative insights that support progress toward the UN Sustainable Development Goals (SDG 6, SDG 3, and SDG 12) and fills a critical gap in the existing literature.</p>