Please cite this paper as: Rodriguez M, Seuc A, Kapp N, von Hertzen H, Huong N, Wojdyla D, Mittal S, Arustamyan K, Shah R, the World Health Organization Research Group on Post‐Ovulatory Methods of Fertility Regulation. Acceptability of misoprostol‐only medical termination of pregnancy compared with vacuum aspiration: an international, multicentre trial. BJOG 2012;119:817–823. Objective To compare women’s acceptance of misoprostol‐only medical termination of pregnancy (TOP) with surgical TOP. Design Prospective cohort study. Setting Termination of pregnancy clinics in New Delhi, Mumbai, Hanoi, Tbilisi, Trivandrum and Yerevan. Population Women requesting TOP, at 63 days of gestation or less, at study sites where both medical and surgical methods were available. Methods Serial surveys eliciting measures of women’s satisfaction and acceptance of TOP method were administered. Data were analysed using cross‐tabulation and logistic regression to determine if TOP method was predictive of acceptability. Main outcome measures Patient acceptance. Results High acceptability of both surgical and misoprostol‐only TOP. Conclusions Where medical TOP with mifepristone is not available, misoprostol‐only medical TOP is acceptable to women who have the choice between medical or surgical techniques.