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Urban malaria has become an important issue in the overall strategies in the control/eradication of malaria in India. This chapter highlights the fact that unplanned and haphazard developmental activities have resulted in deteriorating urban environments, which in turn have created conducive breeding areas for certain malaria vectors such as Anopheles stephensi. This chapter identifies urban regions where malaria surfaced as early as 1962–1963 and implicates construction activities, green belts, and poor water and drainage conditions in the slums as major factors responsible for the spread of malaria. API rates were used to compare malaria occurrence during 1978 and 1993, finding that the above development activities and population resistance to malaria are two of the important factors in variations in malaria patterns over time and space.