Background: Unsafe abortion remains a critical health issue in India, driven by inadequate contraceptive knowledge and access to safe procedures. Manual Vacuum Aspiration (MVA) and Electric Vacuum Aspiration (EVA) are commonly used methods for first-trimester abortions, each with unique safety and efficacy profiles. Hence the aim of the present study was to compare the safety and efficacy of MVA and EVA in first-trimester abortions. Methods: A retrospective study was conducted, over one year, including 100 women with pregnancies under 12 weeks. Patients were randomly divided into MVA (n=50) and EVA (n=50) groups. Clinical outcomes and complications were analyzed using SPSS-20, with significance set at p < 0.05. Results: The gestational age distribution was similar across groups, with most patients in the 6–9 weeks range. Uterine perforation was higher in EVA (6%) than in MVA (2%). Incomplete evacuation was more frequent in MVA (28%) compared to EVA (20%). Blood loss ≥100 ml was observed in 16% of EVA cases versus 8% in MVA. No complications related to anesthesia or cervical injuries were reported. While EVA showed superior efficacy in evacuation, it was associated with higher risks of perforation and hemorrhage. Conclusion: MVA and EVA are effective for first-trimester abortions, with MVA being safer for high-risk patients due to lower perforation and hemorrhage rates, while EVA offers better evacuation efficacy but higher risks of perforation and blood loss. Individualized care and further research are crucial to optimizing clinical outcomes.