American Indians are distinct in their current geographic isolation and history of exclusionary policies enacted against them. Citizenship and territorial policies from the 1700s through the early 1900s have manifested in the distinctive status of many American Indian communities as sovereign nations, a classification that no other ethnic group in the United States can claim. However, as a result of political and geographic isolation, disparities in heath and economic development have been an ongoing problem within these communities. Among the most distinctive health disparities are in infant mortality and obesity-related complications. This project will focus on South Dakota, a state that was late in its application of assimilationist policies, yet today is home to some of the least healthy reservation communities in the United States. An investigation into the making of reservation healthcare delivery systems and patterns of prenatal care utilization will hopefully reveal patterns of health and economic characteristics that predispose infant mortality.