Background:The objective of present study was to compare the safety, efficacy and acceptability of medical method of abortion versus manual vacuum aspiration in early pregnancy termination upto 7 weeks of gestation. Methods: A prospective comparative study was conducted at KNH-IGMC Shimla from 1 st August, 2015 to 31 st July2016 on 100 pregnant women who were willing for termination of pregnancy up to 7 weeks (49 days) of gestational age, in Group A: women who opted for medical method for termination, Group B: women who opted for manual vacuum aspiration for termination. Results: Out of 100 women selected for termination of pregnancy after fulfilling the criteria 62 women had opted the medical method and 38 had opted for MVA. Majority of women residing in urban area preferred for medical method but women from rural area opted MVA to avoid repeated visits. Majority of women opted medical method as it was less painful and not traumatic. Minor side effects like nausea, vomiting and diarrhea were more common among women opted medical method. There were no major complications in any of group like cervical injury, uterine perforation and blood transfusion. Success rate was more with MVA than medical method (97.3% vs 93.5%). However satisfaction rate was more with medical method than MVA (91.9% vs 89.5%). Women of both the groups admitted that they would advise the same method to others if needed. Conclusions: It is concluded from the present study that MVA and medical method both are simple, safe and easy procedures and does not require any special skill. We should allow women to choose the method of termination. This will increase their acceptability, particularly at<7 weeks gestation.