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This study analyzes the practice of prenatal sex selection in rural central China. It examines the prevalence and determinants of prenatal sex determination by ultrasound scanning and subsequent sex-selective abortion. The data are derived from a survey of 820 married women aged 20–44 and from in-depth interviews with rural women and men, village leaders, family planning managers, and health providers, conducted by the author in one county in central China in 2000. Prenatal sex determination was a widespread practice, especially for second and higher-order pregnancies. Sex-selective abortion was prevalent and order of pregnancy, sex of fetus, and sex of previous children were major determinants of the practice. A female fetus representing a high-order pregnancy in a family with one or more daughters was the most likely to be aborted. Awareness among rural families that in the population at large a future marriage squeeze was likely did not diminish the demand for sex-selective abortion.