A micro-level investigation of 983 pregnant women (aged 15–49 years) regarding sex determination and associated factors was carried out in a periurban region of Northern India. Among the women surveyed, 183 chose to use sex determination. The highest percentage of sex determination was among 30–39-year-old women, and general caste and family size were two risk factors associated with sex determination. Correcting imbalances in sex ratios at birth is a complex issue without easy answers, especially in patriarchal societies. Apart from raising awareness among decisionmakers, property rights in favor of women and strict vigilance and record of registration of ultrasound machines are necessary.