Objective To estimate the additional number of needed CS (cesarean section) that would be required in countries with lower than recommended national rates, as well as the number of excess CS in countries in which the procedure is arguably overused and to understand the resource-use implications of the 'needed' and 'excess' CS. Methods We obtained data on the number of CS performed in 137 countries, accounting for approximately 95% of global births for that year. Countries with C-section rates below 10% were considered to show underuse, while countries with rates above 15% were considered to show overuse. We estimated the units costs and the quantities of the physical inputs needed in performing CS. Only the marginal costs of the C-section procedure itself were included. Results A total of 54 countries had C-section rates below 10%, whereas 69 showed rates above 15%. 14 countries had rates between 10 and 15%. We estimated that in 2008, 3.18 million additional CS were needed and 6.20 million unnecessary sections were performed. The cost of the global “excess” CS was estimated to amount to approximately U$S 2.32 billion, while the cost of the global “needed” CS on approximately U$S 432 million. Conclusions Worldwide, CS that are possibly medically unnecessary appear to command a disproportionate share of global economic resources. CS arguably function as a barrier to universal coverage with necessary health services. 'Excess' CS can therefore have important negative implications for health equity both within and across countries.