In this table, we are comparing the differences between an abortion with pills and a vacuum aspiration abortion (manual or electric) method to terminate a pregnancy. It is up to the women to decide which one is best for them according to their budget, availability, location, gestational age, and personal choice.
| What is an abortion with pills (medical abortion)? | What is a vacuum aspiration abortion (in-clinic abortion)? | |
|---|---|---|
| Definition | ||
| Definition | Medical abortion, also known as abortion with pills, is a very safe method used to end an unwanted pregnancy. It involves taking medication that stops the pregnancy from developing and causes the uterus to contract, helping to expel the pregnancy tissue. There are two medically approved options for a safe medical abortion:
safe2choose offers clear, evidence-based guidance on how to safely self-manage a medical abortion using either of these methods. | Manual Vacuum Aspiration (MVA) is a very safe and effective method of abortion, typically used during the first trimester or early in the second trimester of pregnancy. A trained healthcare provider uses a medical device to create gentle suction that removes the contents of the uterus. This procedure can be performed manually using an IPAS device, or with an electric device in what is known as Electric Vacuum Aspiration (EVA). Both methods are medically approved and highly effective. You can find detailed guidelines, including how the procedure works, what to expect, and other essential information, on our "Guide to a Safe Manual Vacuum Aspiration Abortion (MVA)" page. |
| Advantages and disadvantages of an abortion with pills (medical abortion) | Advantages and disadvantages of vacuum aspiration abortion (procedure abortion) | |
|---|---|---|
| Efficacy | ||
| Efficacy | Over 95% effective for Mifepristone & Misoprostol regime 85-93% effective for Misoprostol alone regime | MVA is 98-99% effective |
| Safety | ||
| Safety | Very safe | Very safe |
| Pregnancy test | ||
| Pregnancy test | Pregnancy should be confirmed prior to using the pills. Ultrasound is not required. | Physical exam is required, and ultrasound may be required depending on the clinic. |
| Gestational limit | ||
| Gestational limit | Abortion pills can be used at any stage of pregnancy. However, the number of pills needed, the level of care, and the associated risks may vary depending on how far along the pregnancy is. For pregnancies up to 13 weeks, abortion pills can be safely used at home, and the abortion can be self‑managed by the pregnant person. You can watch our protocol videos to learn more. For pregnancies beyond 13 weeks, a medical abortion requires special care and a different protocol. Please reach out to our counseling team for support. To estimate how far along you are, use our Pregnancy Calculator. | Manual Vacuum Aspiration (MVA) can be performed up to 14 weeks of gestation, while Electric Vacuum Aspiration (EVA) can be performed up to 16 weeks. Please note: The gestational age limit for vacuum aspiration may vary depending on the clinic and the healthcare provider performing the procedure. To find out your gestational age, visit our Pregnancy Calculator page. |
| Location | ||
| Location | An abortion with pills can happen in different places, depending on how far along the pregnancy is and the person’s health. In most cases, it takes place in the privacy of their home, or wherever they feel safe and comfortable. Sometimes, a medical abortion is done at a provider’s facility, where the person stays for a while so a doctor, nurse, or companion can check on them until the process is finished. | The procedure is done in a doctor’s office, clinic, or hospital. Both types of vacuum aspiration can be done at a basic health center, and you don’t need to stay overnight. |
| Carried out by | ||
| Carried out by | It can be self-managed, which means the pregnant woman, girl, or pregnant person can do it by themselves. It can also be done by medical staff or community health workers. It can also be done by medical staff or community health workers. | Can be safely provided by physicians, nurse practitioners, nurse midwives, physician’s assistants (PAs), and others who are adequately trained. |
| Duration | ||
| Duration | The time to completion of the abortion with pills can be a few days to a few weeks. | The time to completion of the vacuum aspiration is minutes. |
| Side effects | ||
| Side effects | After taking the abortion pills, you may start to have cramping and bleeding as soon as 30 minutes, but it can take up to 24 hours to begin. Strong cramps are normal. You can use pain medicine during the whole process. The bleeding might be like your period or heavier, and it may come and go for about 2 weeks or longer. Some other side effects you might have after taking the pills include diarrhea, nausea, vomiting, dizziness, stomachache, headache, fever, and chills. These usually go away within 24 hours after the last dose of misoprostol. Some other side effects you might have after taking the pills include diarrhea, nausea, vomiting, dizziness, stomachache, headache, fever, and chills. These usually go away within 24 hours after the last dose of misoprostol. | Most people will have bleeding and cramping during and after a vacuum aspiration abortion. These symptoms usually get better in the days following the procedure, but it may take 1 to 2 weeks for the bleeding, spotting, and cramping to fully stop. |
| Complications / risks | ||
| Complications / risks | Potential risks include: heavy bleeding, infection, continued pregnancy, and incomplete abortion. | Potential risks include: heavy bleeding, infection, injury to the uterus and surrounding structures, incomplete abortion, continued pregnancy. |
| Cost | ||
| Cost | Generally, abortion with pills is less expensive than vacuum aspiration abortion because it involves purchasing the pills only. An ultrasound, which can be costly, is not required. The exact cost of MA will vary greatly depending on location and whether or not the pills are available over-the-counter at the pharmacy, or by prescription-only. | Typically, vacuum aspirations (in-clinic abortion) are more costly than medical abortions because it sometimes requires some extra testing (i.e. ultrasound), and a skilled professional to perform the procedure. The exact cost of vacuum aspiration will vary greatly depending on location and the respective laws involving abortion. |
| Post-abortion care | ||
| Post-abortion care | A follow-up visit to a clinic is sometimes recommended to make sure the abortion worked, but it’s not always needed. You should contact a provider if you have any warning signs, like heavy bleeding, fever, strong pain, signs of infection, or if you think you’re still pregnant. A urine pregnancy test should show a negative result about 4 to 5 weeks after a successful abortion with pills. Most people can go back to their normal activities when they feel ready. You can find more information about care after an abortion on our Abortion with Pills page or in our Frequently Asked Questions. | Follow-up is sometimes offered after an in-clinic abortion, but it is not required. People should contact their clinic if they experience: heavy bleeding, fevers, severe pain, symptoms of infection or continued pregnancy. A urine pregnancy test will become negative 4–5 weeks after the procedure. Most people can go back to their normal activities when they feel ready after an in-clinic abortion. You can find more details on post-abortion care after a manual vacuum aspiration abortion on our “Guide to a Safe Manual Vacuum Aspiration Abortion (MVA)” page or in our Frequently Asked Questions. |
| Contraception care | ||
| Contraception care | Most forms of contraception can be started immediately after medical abortion. To find the appropriate contraceptive methods of your choice, visit findmymethod.org. | All forms of contraception can be started immediately after the vacuum aspiration abortion procedure. To find the appropriate contraceptive methods of your choice, visit findmymethod.org. |
No, when done using approved methods, abortion is very safe. Both abortions with pills and in-clinic procedures like manual vacuum aspiration (MVA) are effective and rarely (in less than 1% of cases) lead to serious complications. In fact, abortion is safer than many common medical procedures, including childbirth.
The World Health Organization (WHO) says abortions become unsafe or dangerous only when done by someone who doesn’t have the right knowledge or in a place that doesn't follow basic medical standards. The WHO supports self-managed abortions with pills when accurate information is available. safe2choose offers reliable guidance for both methods.
Like any medical procedure, there can be risks, but they are very rare and usually easy to treat. Some examples of complications include an incomplete abortion, heavy bleeding, or an allergic reaction to the pills. Knowing the warning signs and when to seek help is important. See our guide or contact our support team for more info.
Sources:
[1] "Abortion care guideline." World Health Organization, 2022, iris.who.int/handle/10665/349316. Accessed July 2025.
|2] Raymond, E.G., Grimes, D.A. "The comparative safety of legal induced abortion and childbirth in the United States." National Library of Medicine, 2012, Feb;119(2 Pt 1):215-9, pubmed.ncbi.nlm.nih.gov/22270271/. Accessed July 2025.
[3] Jackson, E., et al. "Clinical Updates in Reproductive Health." Ipas, 2023, www.ipas.org/wp-content/uploads/2023/09/Ipas-Clinical-Updates-in-Reproductive-Health-CURHE23b.pdf Accessed July 2025.
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By the safe2choose team and supporting experts at carafem, based on the 2022 Abortion Care Guideline by the WHO, the 2023 Clinical Updates in Reproductive Health by Ipas, and the 2024 Clinical Policy Guidelines for Abortion Care by NAF.
safe2choose is supported by a Medical Advisory Board formed by leading experts in the field of Sexual and Reproductive Health and Rights (SRHR)
carafem provides convenient and professional abortion care and family planning so people can control the number and spacing of their children.
Ipas is the an international organization solely focused on expanding access to safe abortion and contraceptive care
WHO - is a specialized agency of the United Nations responsible for international public health
NAF - the National Abortion Federation – is a professional association in the USA supporting safe, evidence-based abortion care and reproductive rights.
