OBJECTIVE To review the rate, setting, and demographic characteristics of tubal sterilization and its current trend within contraceptive practice in the United States. METHODS Review of U.S. health care statistics, NCHS publications, English-language literature searched using MEDLINE and PubMed, and bibliographies of key references. RESULTS Total annual cases of tubal sterilization have declined from 687,000 in 1995 to 643,000 in 2006, despite a 4% population growth. Interval sterilizations decreased by 12%. Postpartum sterilizations remained stable and follow 8%-9% of all live births. Tubal sterilizations remain more common in black and Hispanic women; women with lower income, lower education, and higher parity; and among women living in the South. From 1981 to 1995, inpatient interval sterilizations fully migrated to ambulatory surgery care. CONCLUSIONS After two decades of stable rates, there is a recent decline in sterilization. Improved access to a wide range of highly effective reversible contraceptives gives women flexibility when deciding how to manage their reproductive ability.