Background: Termination of pregnancy during the first trimester can be safely achieved through the Medical Method of Abortion (MTP) or Manual Vacuum Aspiration (MVA). While both methods are effective, comparative data on safety, efficacy, and patient outcomes remain clinically relevant.

Objectives: To compare the safety, efficacy, complications, and success rates of MTP and MVA in women undergoing pregnancy termination up to 9 weeks of gestation.

Methods: This prospective randomized comparative observational study was conducted at SMS Medical College, Jaipur, including 120 women randomized into two groups (MTP = 60, MVA = 60). Baseline demographics, procedural outcomes, post-procedural bleeding, complications, and success rates were analysed. Statistical significance was set at p < 0.05.

Results: Both groups were comparable in terms of age, socioeconomic status, literacy, residence, religion, and parity (p > 0.05). Complete abortion was achieved in 95% of MTP cases and 100% of MVA cases (p = 0.243). Mean bleeding duration was significantly longer in the MTP group (6.77 ± 3.73 days) compared to MVA (4.17 ± 2.57 days, p = 0.0001). Complications were more frequent with MTP, with higher rates of pain (66.67% vs. 35.00%), nausea (36.67% vs. 13.33%), and vomiting (23.33% vs. 8.33%) (p < 0.05).