If climate change is perceived as a global threat, this can mean that too little attention is paid to the ways in which it affects local populations and settlements. This also means too little attention to the importance of locally driven adaptation, both to reduce risks and to be better prepared to cope with consequences. This paper reviews the many initiatives underway in India that respond to climate change, and discusses what else is needed to mainstream effective adaptation, as well as identifying what currently constrains this. It also discusses how adaptation has to be mainstreamed within urban development and urban governance. Most municipal authorities in India are already grappling with large deficits in infrastructure and services and do not see climate change adaptation as a priority or as their responsibility. However, their attention may be engaged if they can see the co-benefits between adaptation and measures to address development and environmental health concerns.