India has the largest population of dairy cattle in the world at over 48 million animals, yet there has been little formal assessment of their welfare reported. Through observations of dairy cows on 38 farms in Kerala, India, we aimed to investigate the welfare of these animals and the practicality of animal-based assessments within common farming systems. Substantial welfare challenges were identified. All cows were close-tied (less than 1 m length) via a halter that pierced the nasal septum when housed, which was for the entire day (50% of farms) or part thereof. When outside access was available, it was also usually restricted by close-tying, longline tether, or hobbling. Ad libitum water was only available on 22% of farms and food access was also restricted (mean of 4.3 h/day). Future work should focus on encouraging dairy farmers in India to improve the welfare of their dairy cattle by: ceasing to tie and tether cattle (or at least providing tied and tethered cattle with exercise opportunities); providing unlimited access to drinking water and a readier supply of food (especially quality green forage/fodder); cleaning housing more frequently; providing strategies to prevent heat stress; breeding cattle suited to environmental conditions and with increased resistance to heat stress; and carrying out welfare assessments more regularly using a validated protocol and rectifying the causes of poor welfare. Such changes could substantially improve the welfare of tens of millions of cattle.