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This article shows that the reported sex ratio at birth increased substantially in China during the 1980s. An application of the reverse survival method to data from the 1990 census, the 1987 One Percent Population Survey, and the 1988 Two-per-Thousand Fertility and Contraception Survey shows that sex-differential underreporting of births is the most important cause of the high reported sex ratio at birth in China, accounting for about one-half to three-quarters of the difference between reported sex ratios and the value expected under normal circumstances. The increasingly high observed sex ratio of live births delivered at hospitals indicates that prenatal sex determination by ultrasound and other diagnostic techniques (widely available in China) is the second most important cause of the high reported sex ratios at birth. Sex-differential underreporting of births and sex-selective induced abortion after prenatal sex …