This article explores the determinants of road traffic crash fatalities in India. In addition to income, the analysis considers the sociodemographic population structure, motorization levels, road and health infrastructure and road rule enforcement as potential factors. An original panel data set covering 25 Indian states is analyzed using multivariate regression analysis. Time and state fixed-effects account for unobserved heterogeneity across states and time. The rising motorization, urbanization and accompanying increase in the share of vulnerable road users, that is, pedestrians and two-wheelers, are the major drivers of road traffic crash fatalities in India. Among vulnerable road users, women form a particularly high-risk group. Higher expenditure per police officer is associated with a lower fatality rate. The results suggest that India should focus, in particular, on road infrastructure investments that allow the separation of vulnerable from other road users on improved road rule enforcement and should pay special attention to vulnerable female road users.