This cross-sectional study compared the provision of surgical sterilization in public health services in Greater Metropolitan Campinas, São Paulo State, Brazil, and the characteristics of women and men who underwent sterilization before and after its legal regulation. Structured and pre-tested questionnaires were applied to 398 women, 15 directors of municipal family planning programs, and 15 coordinators of basic health units. Eight municipalities in Greater Metropolitan Campinas provided tubal ligation and nine performed vasectomy. Approximately half reported following the guidelines of the prevailing family planning legislation. There were no significant differences before or after legal regulation in terms of the characteristics of women and men sterilized or the waiting time for surgery. Most tubal ligations were still performed in combination with cesarean sections (the additional payment for sterilization had decreased, but the difference was not significant). There is strong evidence that in Greater Metropolitan Campinas the changes expected from legal regulation of surgical sterilization did not materialize. Although progress has been made, several distortions still need to be corrected.