Although there have been significant improvements in post-abortion care programmes around the world, improving pain management has remained a significant challenge. The introduction of manual vacuum aspiration (MVA) has led to many positive changes in programmes, but the guidelines for pain control have generally been vague. Women are often treated with no pain control or in some cases receive too much pain medication. There are many factors contributing to this situation, including: the belief that women who have induced an abortion should be punished, the idea that pain control is unnecessary, the lack of availability of drugs and inadequate training and/or skills of providers. This paper argues for a greater focus on this important element of quality of care and for clearer guidelines on pain management during treatment of incomplete abortion with MVA. This includes the provision of analgesics immediately before the procedure, counselling and reassurance during the procedure and local anaesthesia when necessary.