BACKGROUND To explore women's preferences for pain control during first-trimester surgical abortion. METHODS Pre- and postoperative semistructured individual interviews were conducted with 40 women divided into eight strata by anesthesia choice, age and prior vaginal delivery status. We identified key themes in the interviews and analyzed baseline characteristics and responses to close-ended questions within and across the strata. RESULTS For most women, pain control options were not the primary concern in choosing a clinic for an abortion. Women who received intravenous (IV) sedation had lower pain scores and were more likely to report that they would recommend that method to a friend than women who received local anesthesia alone. Women described the pain as a cramping, tugging, pulling and scraping sensation. Respondents recommended IV sedation for a woman who was very anxious or could not tolerate pain, even though more nausea and vomiting may occur. CONCLUSIONS Most women felt that pain control decisions should be individualized.