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The goal of this study is to identify programs and sociocultural factors underlying disparities in sex ratios at birth in some parts of Nepal, by comparing the situation in districts with high and normal sex ratios at birth and among under-5 children. Findings are expected to inform the design of programs intended to raise the value of girls in general and counter the practice of gender-biased sex selection in particular. The study was conducted in two adjoining hill districts of the western development region of Nepal, namely Kaski (where sex ratios are adverse) and Tanhaun (where sex ratios are normal). The study adopted a mixed method that included a population-based survey of 1,000 married women with at least two children, one of whom was aged 0–5 years, and 29 key informant interviews with district-based public- and private-sector health care providers and program implementers/managers. Data were collected between October and November 2014. This report notes that some background characteristics such as age distribution and religious affiliation of surveyed women were similar, while differences in characteristics and aspects of women’s agency were also observed.