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This project summary indicates that sex ratios at birth in South Asia vary considerably. While the sex ratios at birth in Bangladesh and Pakistan have been normal at the country level (103 and 102.5 males per 100 females, respectively), Nepal is showing signs of disturbed sex ratios at birth, with a sex ratio of 106 males per 100 females, and the situation in India is particularly adverse, with a sex ratio at birth of 110 males per 100 females. In all of these countries, preconditions for a deterioration of the sex ratio at birth are evident. Preferences are expressed for small families, patriarchal social norms persist and societies tend to be gender-stratified with strong preferences for at least one son, and prenatal diagnostic techniques are widely available and used to monitor fetal development. Different research questions were raised for each setting, to shed light on the issue of gender-biased sex selection and make evidence-based recommendations for actions that hold promise for responding to adverse sex ratios at birth.