The academic literature on trade-offs in ecosystem management has paid relatively little attention to justice and poverty reduction objectives. The aim of this paper is to highlight the multiple dimensions of trade-offs in ecosystem services management for poverty alleviation, and to support decision-makers in planning for the almost inevitable trade-offs arising from environmental interventions. The paper brings together different dimensions or lenses through which to analyse trade-offs in ecosystem management for poverty alleviation in a low-income country context. Following a literature review of trade-off decisions, the paper introduces the Balance Sheets Approach to structure trade-off analysis and appraise decisions. We apply the Balance Sheets Approach to analyse five case studies set in very different social-ecological systems where trade-offs were pertinent and undermined poverty alleviation. We show how the combination of ‘positive’ approaches, often used at strategic level, with ‘value’ approaches which analyse multiple values, multi-scale governance, power and capacity, is necessary to analyse complex trade-offs. Based on the case studies we identify four lessons for future trade-off analysis in the context of ecosystem management for poverty alleviation in low-income settings.