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Criteria for comparing early first trimester abortion by drug protocol with early abortion by vacuum aspiration are critically reviewed. Contextual influences on medical practice are shown to be more determinant of method choice than technical advantages of one procedure over the other. The paper demonstrates how the following social factors can shape the practice and evaluation of each method : clinical policy, procedural protocols, presentation of alternatives, service accessibility, sexual division of labor among practitioners, cultural styles of health care and gender ideology. Analysis suggests that either method can be an effective tool for women’s reproductive autonomy or a punitive means of sexist surveillance