Chi Linh district, which locates in the Red Delta River region, has been recognized as the “hot pot” of high sex ratio at birth in Vietnam. This paper used community-based periodic Demographic-Epidemiologic Surveillance System (CHILILAB) to describe sex ratio at birth (SRB) and identify social - economic factors that related to the SRB. A total 5,940 births born from August 1, 2004 to August 31, 2011 was included in analysis. The SRB of 116.6 boys/100 girls (CI: 110.7 – 122.5) was significantly higher than normal. SRB were found high among second child having only older sister(s), among third child and higher birth order, among mothers who were 35 years and older, running small business or homemakers. Interestingly, a SRB of 91.4 boys/100 girls (CI: 81.8 – 102) was found among second children having an older brother, this is significantly lower than the normal level. Further research should be done to assert if abortion is practiced both to have a son and to have a daughter.