There is no doubt that existing health care delivery system is very poor in rural India especially in the localities of backward, marginalized tribal, and under-privileged communities due to several apparent infrastructural lacune, constraints, limitations, and excuses. Added to these adversaries, are the ample prevalence of birth defects/genetic disorders among these poverty stricken vulnerable communities. There were 705 scheduled tribes and subtribes, and 75 Primitive Tribal Groups in India as per 2011 Census, which constituted about half of the indigenous people of the world! A huge mass of dwindling people has virtually no access to genetic services, available only to a few in big cities at exorbitant cost, and utterly lacking in rural India. This epidemiological review related to public health genetics, highlights the genetic burden/magnitude of hemoglobinopathies having glimpses of reproductive and child health, and neonatal/infant mortality in afflicted couples in the three states of India, namely, Chhattisgarh, Madhya Pradesh, and Odisha. With over emphasis laid on bringing awareness and imparting genetic/marriage counseling, carrier detection and establishment of prenatal diagnostic facilities at least in the vicinity of at risk communities. Cost of establishment of such infrastructural facilities is still lower than the potential benefits to the people. Therefore, it is high time to introduce the genetic services in the existing health systems approach.