Groundwater in the Qingshui River Plain of southern Ningxia is one of the main water sources for local domestic and agricultural use. However, due to the geological background of the area, 33.94% of the groundwater samples had fluoride concentrations that exceeded the WHO drinking water standards. To examine the spatial patterns and formation processes of fluoride in groundwater, researchers gathered 79 rock samples, 2618 soil samples, 21 sediment samples, 138 groundwater samples, and 82 surface water samples across the southern Qingshui River Plain. The collected data were analyzed using statistical approaches and hydrogeochemical diagrams. The findings reveal that fluoride levels in groundwater exhibit a gradual increase from the eastern, western, and southern peripheral sloping plains toward the central valley plain. Vertically, higher fluoride concentrations are found within 100 m of depth. Over a ten-year period, fluoride concentrations have shown minimal variation. Fluoride-rich rocks, unconsolidated sediments, and soils are the primary sources of fluoride in groundwater. The primary mechanisms governing high-fluoride groundwater formation are rock weathering and evaporative concentration, whereas cation exchange adsorption promotes fluoride (F⁻) mobilization into the aquifer. Additional sources of fluoride ions include leaching of fluoride-rich sediments during atmospheric precipitation infiltration and recharge from fluoride-rich surface water.