CONTEXT: Official data on sex ratios at birth suggest a rise in sex-selective abortions in some post-Soviet states following the introduction of ultrasonography. However, questions remain about the validity of official data in these nations as well as whether the high sex ratios at birth are a statistical artifact. METHODS: Trends in sex ratios at birth from 1985 to 2009 for 12 post-Soviet states were examined using vital registration data. For the three countries that had had a Demographic and Health Survey (DHS) in 2005-2010 (Armenia, Azerbaijan and Moldova), survey data were used to calculate sex ratios at birth according to birth order, and vital registration data for 2010 were used to estimate the number of "missing" female births (if any). RESULTS: Official data revealed elevated sex ratios at birth in Armenia (117), Azerbaijan (116) and Georgia (121), but not in other post-Soviet states. According to DHS data, sex ratios were high in Armenia and Azerbaijan for first births (138 and 113, respectively); if the first child was a girl, the sex ratio in Armenia was even higher for the second birth (154). Overall, the number of girls born in these countries in 2010 was 10% lower than expected, consistent with 1,972 sex-selective abortions in Armenia and 8,381 in Azerbaijan. Sex ratios did not vary by birth order in Moldova. CONCLUSION: Sex-selective abortion appears to be common in Azerbaijan and Armenia. Family planning and legal interventions are needed to address this issue.