In Nepal, as in many Asian countries, son preference is very strong, due to the country’s longstanding patriarchal social structure. According to the 2001 census, sex ratios (computed as the number of males per 100 females) for those younger than 1 year of age were over 106 in seven districts in the Tarai plains and one hill district. This study subsequently aimed to identify the incidences, causes and determinants of pre-natal sex selection in four of these eight districts. Three of the four districts (Dhanusha, Parsa, Kapilbastu) lie in the Tarai belt bordering India, while the fourth district (Gorkha) lies in the central hills. In addition, the study examined the situation in three border routes connecting Nepal with major towns in India, and in Kathmandu Metropolitan City, to assess the availability and accessibility of pre-natal sex-selection technologies in these areas.