Some countries have for many years witnessed distorted sex ratios in the sense that the share of male population is larger than one would expect based on “natural” gender ratios at birth and mortality rates. This imbalance is often the result of son preference, rooted in cultural and economic experiences, and accentuated by declining fertility and pressures to have smaller families. With a focus on China and India, where skewed sex ratios have been highlighted by the international community and recognised by their governments, this study reviews the key literature exploring the causes, current trends and consequences of sex selective practices from infanticide and neglect to more modern sex determining and selective practices such as ultrasound tests and consequent sex selective abortions. Despite legislation regulating sex selection in both China and India, these practices are difficult to monitor, with medical practitioners and equipment suppliers reaping profits from the procedures. Skewed ratios have also been observed in other countries, such as Vietnam, Albania, Azerbaijan and Georgia. Normalisation of sex ratios cannot be achieved by simply controlling the use of sex selective technologies. A sustainable way to reduce sex selection requires strategies which focus on countering the gender inequality that drives son preference. An issue already addressed by the European Assembly, the European Parliament has a role to play in highlighting the issue through its relevant committees, such as Committee of Development, Human Rights, International Trade and Women’s Rights and Gender Equality, as well as through their country-specific delegations, as well as in the upcoming Multi-Annual Financial Framework 2014-2020.