Background: Despite numerous awareness campaigns, rural women in Odisha have serious disparities in reproductive health. Strong cultural preferences for sons lead to uneven fertility trends, which negatively impact fertility decisions. The low sex ratio at birth in rural areas emphasizes the continued existence of gender bias, even if Odisha's overall sex ratio (979 girls per 1,000 men) is higher than the national average. The study's objective is to evaluate the variables affecting the fertility practices and son preferences of Odisha women. Methodology: This study included both primary and secondary data. In this study, 20,037 married women between the ages of 15 and 49 are analysed using SRS data from 1997 to 2023 and NFHS-5 (2019–21). Additionally, primary data from 150 married women in the Bhadrak district's Chandbali block were examined. The main factors influencing fertility decisions were examined using both bivariate and multivariate analysis. Results: The study discovered a negative correlation between the number of children and the mother's educational attainment. Higher educated women (OR: 0.687, p<0.000) have a lower chance of getting pregnant than uneducated women. Son preference is one significant element affecting the trajectory of reproduction. Fertility is negatively associated with women who desire to have fewer males (OR: 0.313, p < 0.001) and positively associated with women who prefer to have more girls (OR: 3.156, p < 0.001). Sons would be their ideal child, according to 72% of respondents, according to primary data, demonstrating a strong societal preference for male offspring. Additionally, 76% of participants expressed feeling pressured by their families to have more children. Conclusion: The primary data showed that persistent son preference, which is driven by socioeconomic circumstances, has a significant impact on fertility behaviour. Education, women's empowerment, and reproductive health care must be strengthened to reduce gender discrimination and achieve equitable fertility results.