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Nationally, the sex ratio at birth has persisted at its natural level of 105 male per 100 female newborns for the past half century in Bangladesh. However, at the regional level, Bangladesh is characterized by an east-west divide in sex ratios at birth. While the western region shows normal sex ratios at birth, the eastern region displays distorted sex ratios. To understand the factors that contribute to regional variations, a household survey was conducted among married women aged 18–49 years who had at least two living children. Views of health-care providers on gender-biased sex selection and of program implementers on the impact of gender-focused programs on the importance of having a daughter in the family were also gathered. The study was located in Comilla district which had an adverse sex ratio at birth, and Rangpur district having a normal sex ratio. Caution should be exercised in interpreting the findings, as the sample size of women interviewed was not adequate to reach a definitive conclusion. Future studies are needed that work with a larger sample.