A study of the abnormal sex ratio at birth in China reveals that it is not an entirely new phenomenon that emerged since the 1980s, but is simply more visible at present. Deliberate intervention to determine the sex of children has existed in the past few decades, at least in certain groups. Apart from modern medical methods, traditional Chinese medical practice is shown to be highly accurate in identifying the sex of a fetus. This may lead to sex-selective abortion and an abnormal sex ratio at birth. The possible causes of the abnormal sex ratio at birth include not only the real imbalance due to the disturbance of social factors, but also a spurious one attributable to the under-counting of female births. The real magnitude of the imbalance has been exaggerated by statistical error. The phenomenon is a complicated one reflecting the comprehensive socioeconomic setting. Among these factors, the stage of the fertility transition is one of the most decisive.