Objectives. We examined variations in the prevalence of postpartum tubal sterilizations following cesarean sections (C-sections) from 2000 to 2008. Methods. We used data from the National Hospital Discharge Survey (NHDS) to estimate odds ratios for patient- (race, marital status, age) and system-level factors (hospital size, type, region) on the likelihood of receiving tubal sterilization after C-section. Results. A disproportionate share of postpartum tubal sterilizations following C-section was covered by Medicaid. The likelihood of undergoing sterilization was increased for Black women, women of older age, and non-single women. Additionally, they were increased in proprietary and government hospitals, smaller hospital settings, and the Midwest and Southern regions of the country. Conclusions. This adds to the growing body of evidence that suggests that tubal sterilization is a disparity issue patterned by multiple factors and calls for greater understanding of the role of patient-, provider-, and system-level characteristics.