OBJECTIVE: To estimate variation across hospitals in the rate of postpartum sterilization. METHODS: All hospitals with deliveries in California and Texas in 2009 were included. Proportion of live singleton deliveries with postpartum sterilization was calculated by hospital, insurance status (Medicaid compared with private insurance), type of delivery, and state. RESULTS: Within each insurance status in California and Texas, we found wide variations across hospitals in postpartum tubal sterilization rates. This variability was not explained by disparities in hospital cesarean delivery rates. Some, but not all, of this variation was attributable to the absence of sterilizations in Catholic hospitals. Overall, postpartum tubal sterilization rates were higher in Texas than in California (10.2% compared with 6.7%), and this difference was found among both public insurance and private insurance patients. Interval sterilizations were more frequent in California, but the difference was not large enough to offset the difference in postpartum sterilization. CONCLUSIONS: The variation in postpartum tubal sterilization rates across hospitals is substantial and exists even among hospitals without religious affiliations. Large-scale studies are needed to assess the demand for, and the barriers to, obtaining postpartum sterilization. LEVEL OF EVIDENCE: II © 2012 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins.