This chapter explores the ever-changing scenario of urbanization in India, presenting substantial challenges to the well-being of its extensive river networks. Rapid urban development exerts pressure on rivers, leading to alterations in hydrology, geomorphology, and water quality. The study employs geospatial techniques to comprehensively monitor and map the physical, chemical, and biological effects of anthropogenic activities in river basins across the country. The impact of urbanization on river health is manifested in various forms, including changes in stream hydrology and geomorphology. Additionally, the deterioration of water quality is a prominent concern, stemming from increased urban demands for water and the subsequent discharge of pollutants. Urban areas, as a consequence, face heightened risks of flooding due to these alterations. This research not only identifies the multifaceted challenges arising from urbanization but also offers recommendations for effective river health management. These suggestions aim to mitigate the adverse effects on river ecosystems and promote environmental sustainability. By utilizing geospatial techniques, this study provides a holistic understanding of the complex interplay between urbanization and river health, offering valuable insights for policymakers and stakeholders involved in sustainable river management.