Women in India are rarely given a choice about their pain management methods for first trimester abortions. To investigate women's preferences and perceptions of pain, we allowed 100 women in Mumbai to choose between local and general anesthesia (60% selected general, while 40% elected local anesthesia). Using visual analog scales ranging from 1 to 7, women characterized their pain several times during their abortion visits. Local anesthesia clients reported more pain during (2.3 local vs. 1.0 general) and immediately after (1.9 vs. 1.0) the procedure. By three hours post-procedure, none of the women in either group reported any pain. General anesthesia clients reported that having no pain (95%) or anxiety (38%) were the best features, while local anesthesia clients liked being ambulatory (26%), avoiding side effects (26%), and feeling awake (21%). Though women in both groups were satisfied, local anesthesia clients were more likely to recommend it to friends (95% vs. 85%). Given these advantages, our study suggests that some women willingly accept additional pain incurred by exchanging local for general anesthesia.