Large numbers of households in cities around the developing world do not have access to one of the most basic of human needs–a safe and reliable supply of drinking water. This paper uses the experience of India as a lens through which to view the problems of access to water in urban areas and the various options available for reform. Using two sets of data from the National Family Health Survey, as well as published and unpublished secondary sources, the paper presents the status of access to drinking water in urban India, the performance of India’s urban water sector compared to other Asian metropolitan regions and the reform efforts that are under way in several Indian cities. A review of these ongoing reforms illustrates some of the political economy challenges involved in reforming the water sector. Based on this analysis, we draw out directions for more effective research, data collection and policy reform. While each country faces unique challenges and opportunities, the scope and range of the Indian experience provides insights and caveats for many low-income nations.