The shoulder width, as a geometric element, plays a crucial role in enhancing highway safety. Research from high-income countries indicates that improving shoulders on highways leads to substantial safety benefits. However, the safety effectiveness of paved shoulders for low- and middle-income countries (LMICs) highway contexts has limited evidence. This study evaluated the safety effectiveness of the paved shoulder width on 61 km, four-lane, divided rural intercity highways in India. The first objective was to evaluate highway crash patterns using data from 2016 to 2019. The second objective was to evaluate the safety effectiveness of paved shoulder width using the case-control approach. The findings of this study demonstrate a consistent decline in the likelihood of crashes as the shoulder’s width increases within the range of zero to 2.5 m for the 100 m segment length and zero to 1.7 m for the 500 m segment length. Nevertheless, model estimates indicate an increased crash risk for shoulders wider than 2.5 m. The results also suggested that the odds ratio for paved shoulder widths ranging from no shoulder to 2.5 m is likely to follow the crash modification factor from the highway safety manual. The findings of this study hold significant implications for the design policy of shoulder width on rural highways in LMICs.