Health choices in transition: a systematic review and meta-analysis of self-medication in India across diverse populations and locations before, during, and after the COVID-19 pandemic

Background Self-medication is a growing public health concern, especially in low- and middle-income countries like India. Despite its widespread practice, a comprehensive national-level synthesis of the prevalence and demographic patterns of self-medication in India has been lacking. This systematic review examines that gap by assessing self-medication prevalence across diverse populations, states, regions, and time periods in India. Methods A systematic search was conducted across three major databases—PubMed, Scopus, and Web of Science—to identify peer-reviewed articles on self-medication in India. Studies were screened for eligibility using the PRISMA 2020 Statement, and a total of 145 studies comprising 69,876 participants were included in the meta-analysis. The quality assessments of the included articles were conducted using the JBI checklist for critical appraisal. The pooled prevalence estimates were calculated using random-effects models. Subgroup analyses were conducted by population groups, regions, and time periods (pre-, during, and post-COVID-19 pandemic). Results The pooled prevalence of self-medication in India was 61.1% (95% CI: 0.57–0.65). A temporal analysis showed that studies conducted during and after the COVID-19 pandemic had higher prevalence estimates than those conducted before the pandemic, with pooled estimates of 57%, 61%, and 63%, respectively. Among social groups, self-medication was most prevalent among students, whereas among physiologic groups, older individuals showed relatively high prevalence and pregnant women exhibited the lowest prevalence. Regional variation was notable: the Central, Northern, and Western regions exhibited the highest prevalence. Considerable variation was also observed across states and cities, although some estimates were based on a small number of studies and should be interpreted cautiously. Conclusion Self-medication in India is prevalent and varies substantially across populations, regions, and time periods, with studies conducted during and after the COVID-19 pandemic reporting higher prevalence estimates than those conducted before the pandemic. Students and older adults bear a disproportionate burden, highlighting the need for targeted educational interventions. These findings underscore the urgency of robust public health policies and regulatory frameworks to monitor and curb self-medication, particularly in high-prevalence areas. Key limitations include the lack of prospective PROSPERO registration, restriction to English-language studies, and exclusion of grey literature.