<i>Introduction: </i>Regardless of the fact that it is highly effective, inexpensive, non-hormonal, and immediately reversible; in developing countries, including Ethiopia, the acceptance rate of postpartum intrauterine contraceptive devices was not well known. Hence, the goal of the study is to determine acceptance level and associated factors among women delivered in public hospitals of North shoa zone. <i>Method: </i>A Hospital based cross-sectional study was utilized. A pre-tested questionnaire was used to collect data. The collected data were entered into Epidata version 4.6.0.2 and then exported to SPSS version 26 for analysis. Binary logistic regression analysis was used to identify the independent effect of predictors on outcome variables. Those variables with a P-value of ≤ 0.25 during bivariable logistic regression analysis were the candidate for multivariable analysis. Adjusted odds ratio (AOR) at 95% CI was used to assure statistical significance association between acceptance level of immediate post- partum IUCD and associated factors with p-value ≤ 0.05. Finally, findings of study were presented using narration, table, Chart and graph. <i>Results: </i>This study had included 534 delivered women to assess the acceptance level of immediate PPIUCD and its associated factors. Women's occupation (government employee) (AOR=3.23, 95% CI: (1.23-5.95)), Favorable attitude ((AOR = 10.93, 95% CI: (4.93-23.89)) and Knowledge toward IUCD (AOR=2.56, 95% CI: (1.70-8.26)) were factors identified to be associated with the acceptance level of immediate PPIUCD. <i>Conclusion and recommendations: </i>The acceptance level of immediate postpartum intrauterine contraceptive device was low. Maternal occupation, maternal knowledge about IUCD and attitude are associated with the acceptance level. Health education, a change in women's attitudes, and frequent training for healthcare workers are very important.