Background: Early pregnancy termination can be done by surgical and medical methods. Choice of the methods depends upon the period of gestation and women preference. Aim: To compare the safety and efficacy of manual vaccum aspiration & medical method (with mifepristone and misoprostol) in the management of early pregnancy termination (up to 9 weeks). Study design - Prospective study Study time period – 6 month from January 2019 to June 2019 Material and Method:104womenwereselectedfor first trimester abortion up to 9 weeks from outdoor of Department of Obstetrics and Gynecology, PMCH Patna, Bihar. In group1-women who opted for vaccum aspiration and in group2- women who opted for medical abortion. All women were counselled & explained about both the methods in detail. Women were given the option of selecting medical abortion with mifepristone and misoprostol or manual vacuum aspiration. Those without a preference were randomly assigned to a method. Outcome were measured just after procedure and 14 days post abortion follow up visit. Result: Most of the women coming for termination of pregnancy belongs to urban area. Méan age of women in group 1 is 26.80 ± 3.63 yrs and in group 227.65 ± 3.50. 10 women were nullipara and majority of them (72.72%) opted for medical abortion. (P. value = <0.05) which is statistically significant showing more inclination of nulliparous women toward non-invasive procedure.12 women were Para-1, 56 women Para-2 & 26 women were multipara. Chi-Square Value is 0.953, Degree of freedom is 2 & P. Value 0.621.Other than nulliparous women there is no significant association between parity and two groups. Average gestational age in Group 1 was 48.9 ± 6.28 days and in Group 2 was 47.2 ± 6.87 days. Most of the patient in less than 42 days gestation opted for medical abortion. Average duration of bleeding in Group 1was6.77 ± 2.86 days and in Group 2 was8.57 ± 3.96 days (pvalue< 0.05).Amount and duration of vaginal bleedingis more in medical abortion group which is statistically significant. Incomplete abortion noted in 2 cases in medical method group. Success rate of MVA was 100% with no product of conception found in any patient were as in medical method the success rate was 96.15% in which two patient had incomplete expulsion. Conclusion: MVA is more efficacious then medical method in terms of complete evacuation of product of conception, Medical method provide a non invasive alternative choice for early pregnancy termination according to clinical examination and women preference.