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Background Contraceptive use has increased impressively in the last years. Our aim was to track the proportion of female sterilization in demand for family planning satisfied with modern methods (mDFPS) and its inequalities in terms of wealth. Methods Using data from national health surveys carried out since 2010 in 105 countries, we estimated mDFPS, separating according to type of method. Where the share of female sterilization was at least 25%, we analysed wealth inequalities in the share of sterilization by wealth quintiles and Slope Index of Inequality (SII). Results We included 20 countries, among which mDFPS varied widely (from 6% in Albania to 94% in Brazil). Female sterilization was reported by more than half of women in India, Dominican Republic, El Salvador, Mexico, and Colombia. Most countries presented higher use of sterilization among the richest, but inequality patterns varied greatly. Higher levels of pro-rich inequality were found for Guatemala and Costa Rica (SII of 0.24 and 0.22, respectively). Higher levels of pro-poor inequality were found for Albania and Brazil (SII of -0.25). Conclusions Despite the wider range of methods available, several countries present a large proportion of mDFPS satisfied through female sterilization. Key messages Sterilization might be recommended to some couples, however, its role in mDFPS is excessively high. Promotion of long-acting reversible contraceptives should be strengthened as they are easy to use, highly effective and do not eliminate women’s agency about maternity in the future.

709Inequalities and the role of sterilization in modern contraception in low- and middle-income countries