Hoxha I, et al. - Via searching PubMed, Embase, the Cochrane Library and CINAHL from the first year of records to April 2018, researchers evaluated the odds of caesarean section (CS) for uninsured women in the USA and understood the underlying mechanisms as well as effects of lower use. Studies were included that reported data to allow the calculation of ORs of CS of uninsured as compared with insured women. This systematic review and meta-analysis included 12 articles describing 16 separate studies involving more than 8.8 million women. In uninsured women, CSs are less likely to be performed vs insured women. While the higher CS rates among private insured women can be explained by private insurance-related financial incentives, the lower odds among uninsured women draw attention to barriers to delivery care access. The rates for uninsured women in many regions are above, close or below the benchmarks for suitable CS rates and may imply both underuse and overuse. Therefore, it is important to evaluate the delivery results as well as policy options that could improve insurance coverage for birth-giving women.