Despite the widely acknowledged importance of involving Indigenous peoples in decision-making processes around water, no comprehensive systematic review has examined how Indigenous peoples participate in water governance processes. This paper provides the first global systematic assessment of peer-reviewed literature on Indigenous peoples’ participation and inclusion in water governance. A total of 222 peer-reviewed journal articles were reviewed, encompassing 182 case studies across 15 countries. The majority of reviewed articles (85%) focused on settler-colonial nations—Australia, Canada, the U.S., and New Zealand—while regions like Africa and Asia remain underrepresented in the literature. Findings also indicate that most Indigenous participation occurs domestically, primarily at local levels, with limited examples of Indigenous participation at the global scale. Moreover, only 18% of the studies of participation gave any consideration to Indigenous values and knowledge. Gaps include limited studies with evaluation of Indigenous participation and detailed accounts of participatory processes, highlighting priorities for future research.