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The South Asian summer monsoon is a complex coupled human-natural system that poses unique challenges for understanding its evolution alongside increasing anthropogenic activities. Rapid and substantial changes in land-use, land-management and industrial activities over the subcontinent, and warming in the Indian Ocean, have influenced the South Asian summer monsoon. These might continue to be significant drivers in the near-term along with rising global greenhouse gas emissions. Deciphering the region's vulnerability to climate change requires an understanding of how these anthropogenic activities, acting on a range of spatial scales, have shaped the monsoon spatially and temporally. This review summarizes historical changes in monsoon rainfall characteristics, associated mechanisms, and the role of anthropogenic forcings, focusing on subseasonal variability and extreme events. Several studies have found intensified subseasonal extremes across parts of India and an increase in spatial variability of rainfall despite an overall weakening of seasonal rainfall in the monsoon core. However, understanding these changes remains challenging because of uncertainties in observations and climate models. The mechanisms and relative influences of various anthropogenic activities, particularly on subseasonal extremes, remain relatively underexplored. Large biases in the representation of relevant processes in global climate models limit the ability to attribute historical changes and make reliable projections. Nevertheless, recent advances in modeling these processes using higher-resolution modeling frameworks provide new tools to investigate the Indian summer monsoon's response to various anthropogenic forcings. There is an urgent need to understand how these forcings interact to shape climate variability and change in this vulnerable region. This article is categorized under: Paleoclimates and Current Trends > Earth System Behavior