<p>Rheumatic heart disease (RHD) remains a significant public health concern in India, disproportionately affecting women in the child-bearing age. Delayed diagnosis, limited awareness, and inadequate access to specialized cardiac care, contribute to advance disease presentation and poor outcome. Despite the availability of early detection tools and effective antibiotic prophylaxis, many Indian women are diagnosed at the late stages, necessitating complex surgical interventions such as balloon valvuloplasty, valve repair, or valve replacement. Surgical management presents unique challenges particularly regarding the choice between the mechanical and bioprosthetic valves, as the former requires lifelong anticoagulation therapy which poses risk during pregnancy. Socioeconomic impacts of RHD on women include not only financial constraints and loss of productivity but also significant disparities in healthcare access which further hinder timely and effective treatment. This narrative review will provide the comprehensive overview of the current state of research in a specific field and would explore the multifaceted surgical implications of RHD in Indian woman, and would also address demographic consideration, including the age of onset; clinical, reproductive, and hormonal factors; and socio-economic dimensions which influence disease progression and surgical outcomes. It also emphasizes the importance of early screening programs, tailored surgical strategies, and a multidisciplinary approach to care including preconception counselling and postoperative follow-up to improve outcomes. Addressing these gaps is essential to reduce the morbidity and mortality, and enhancing the overall quality of life for woman affected with RHD in India.</p>