Intersecting Governance Structures, Implementation Processes, and Indigenous Family Centered Policymaking

Abstract

States’ power over policymaking continues to grow, resulting in increased attention to the United States’ (U.S.) federalist system of government in social welfare policy research. As in other issue areas, this focus has been prominent in reproductive, maternal, and child health (RMCH) (Chin et al., 2024). Public funding and legal regulations surrounding childcare subsidies, abortion access, perinatal Medicaid benefits, paid family leave, and many other RMCH supports vary widely across states (Prenatal-to-3 Policy Impact Center, 2025). This variation has particularly acute impacts for communities who already experience the brunt of RMCH inequities, including Indigenous populations (Abrahamson-Richards et al., 2025; Chin et al., 2024; Michener 2018; Michener 2022; Schnake-Mahl et al., 2023). However, the unique governance relationships that Tribal Nations and other Indigenous communities have with the U.S. are too often overlooked within analyses of the federalist system and its impacts on the services and supports communities have available to them. Furthermore, persistent RMCH inequities among Indigenous communities, even within more politically progressive state policy environments, suggests that state profiles as predictive constructs are insufficient in Indigenous social policy research. Given that the overall nature of the state policy environment cannot soundly account for Indigenous RMCH outcomes, this dissertation investigates how state policy systems influence RMCH wellbeing among the first peoples of the U.S. and U.S.-occupied Pacific territories, with a primary focus on Washington State. Abrahamson-Richards utilizes multiple modes of inquiry to conceptualize state-level governance in a U.S. context through the lens of Indigenous political geographies, both physical and epistemic. Using interviews with Indigenous RMCH leaders, interviews with state paid leave program administrators, and policy systems observation, the set of studies within the dissertation explore the ways in which overlapping borders and jurisdictions shape Indigenous well-being in the reproductive and early parenting realms.