Research on sex preference for children has largely focused on Southern and Eastern Asian countries and overlooked the region of formerly Soviet Central Asia. Using the 2002 Uzbekistan Health Examination Survey and qualitative data collected in 2005 and 2006, I explore the preference for male births as it affects contraception, abortion, and fertility in a country well into its fertility transition. Findings indicate that, while son preference has a small influence on current contraceptive prevalence, the overall sex ratio at birth may mask substantial parity-specific differences. For births at certain orders, the calculated sex ratio does not fall in the normal range and may indicate the presence of an artificial intervention. Further, results of proportional hazards models indicate a substantial effect of son preference on fertility. I use focus group and individual and expert interview data to explain this phenomenon in economic and cultural terms.