Outdated second trimester abortion methods are still being used in some countries, and very few studies have compared them to currently recommended methods. To this end, we studied the efficacy and safety of vaginal misoprostol used alone for abortions in 189 women at 13-20 weeks gestation, in 2004-2006. We also retrospectively collated similar data from an historical cohort of 189 women drawn consecutively and chronologically from hospital records from 2003-2006, also at 13-20 weeks gestation, who had had abortions with a combination of extra-amniotic 0.1% ethacridine lactate solution, oxytocin and sharp curettage. At 24 hours, misoprostol was 92.6% effective in inducing abortion versus 76.2% with the ethacridine lactate regimen (OR 4.2, 95% CI 2.3-8.0). The misoprostol cohort experienced fewer complications than the ethacridine cohort (4 vs. 38 cases, OR 0.086, 95% CI 0.03-0.23). We conclude that in the absence of mifepristone, misoprostol alone is preferable to the ethacridine regimen for the termination of pregnancy in the second trimester, because it works faster, has a higher success rate in a shorter period of time, and fewer complications.