Aims of study: To study the outcome of buccal and vaginal administration of Misoprostol in first-trimester induced abortions. To study the induction-abortion interval, duration of bleeding, failure rate, side effects, and patient satisfaction among both routes. Materials and methods: A prospective observational study was carried out on 110 women requesting for first-trimester abortion as per medical termination of pregnancy (MTP) Act. They were divided into two groups, i.e., vaginal and buccal. The vaginal group comprised 55 patients who were given oral Mifepristone, followed by vaginal Misoprostol (800 µg). In the buccal group, consisting of 55 patients, oral Mifepristone was administered, followed by buccal Misoprostol (800 µg). Results were compared between the groups in terms of induction-abortion interval, duration of bleeding, failure rate, side effects, safety, effectiveness, and patient satisfaction. Results: The rate of complete abortion was 92.7% in the vaginal group and 91% in the buccal group. No statistically significant difference was found in the rate of complete abortion among both groups. The side effect profile was similar among both the groups, except for altered taste in the buccal group. No statistically significant difference in patient satisfaction was observed in the groups. Conclusion: Buccal and vaginal routes of administration of Misoprostol have similar efficacy and patient satisfaction. Clinical significance: For first-trimester medical abortion, Misoprostol can be used in various routes. The vaginal route, requires repeated vaginal examinations which becomes inconvenient for the patients. The buccal route can be used as an effective alternative to the vaginal route.