Experience is reported with the elective 1st trimester abortion of 16,410 pregnancies during a 31 mo. period by Reproductive Health Services of St. Louis [Missouri, USA], a free-standing clinic. Incidence of complications was 1.54%. The most common of these were incomplete evacuation, excessive postabortal bleeding and uterine perforation. In patients with unquestioned perforation, the use of laparoscopy was very valuable in ascertaining the exact nature of the perforation, in avoiding unnecessary laparotomy, and in giving intraabdominal visual guidance to concomitant suction evacuation in cases of an incomplete procedure. Aspects of the other complications were also discussed. Even in the 1st trimester, the earlier in pregnancy that suction abortion is performed, the less likely it is to result in major complications. It is possible to perform 1st trimester abortions in a free-standing clinic with a satisfactorily low complication rate.