This article reviews the growing interdisciplinary literature on the effect of privation and stress on human sex ratio at birth. Borrowing strength from the potential outcomes causal analysis framework, the discussion focuses on the issues of study design and identification strategy and how they have influenced the current state of the field. The review suggests that much of the inconsistency in the literature regarding the effect of privation and stress on human sex ratio at birth is due to the weak designs and over-simplistic identification strategies used in previous studies. Studies based on natural experimental designs and well-thought-out identification strategies, on the other hand, have produced rather compelling and consistent evidence suggesting that maternal privation and stress during pregnancy reduce male births.