BackgroundCOVID-19 vaccination during pregnancy is a common practice in developing countries like Ethiopia. Despite there being a rumor from the community that the use of COVID-19 vaccination during pregnancy is associated with many pregnancy adverse outcomes. However, there is a paucity of empirical evidence on the perception of risk COVID-19 vaccination during pregnancy in Ethiopia. This study assessed the perception of risk COVID-19 vaccination during pregnancy and associated factors in Motta town and Hulet Eji Enese district, northwest Ethiopia.MethodsA community-based cross-sectional study was conducted from December 12 to February 12, 2021. A total of 851 women’ were selected using the stratified cluster sampling technique. Data were collected by face-to-face interview using a semi-structured pretested and interviewer-administered questionnaire. A multivariable logistic regression model was fitted to identify factors associated with the perception of risk COVID-19 vaccination during pregnancy. The adjusted odds ratio (AOR) with a 95% confidence interval at a p-value of ≤ 0.05 was used to declare the level of significance.ResultsPerception of risk COVID-19 vaccination during pregnancy was 34.2% (95%CI (Confidence Interval): 31–37). Unplanned pregnancy (AOR = 3.66; 95%CI: 2.31–5.81), long travel time to the nearby health care facility (AOR: 4.57; 95% CI: 2.34–8.91), have no formal education (AOR: 3.15; 95%CI: 1.71–5.79), attending secondary educational level (AOR: 5.18; 95% CI: 2.17–12.4), no ANC (Antenatal Care) service utilization (AOR: 7.07; 95% CI: 4.35–11.5) and negative attitude towards COVID-19 vaccination (AOR: 6.05; 95%CI: 3.88–9.43) were significantly associated with the perception of risk COVID-19 vaccination during pregnancy.ConclusionsMost of the participants perceive COVID-19 vaccination during pregnancy as a risk for the outcome of pregnancy. Designing strategies to increase women’s educational status, promoting the need for maternal and child health services, and awareness creation regarding COVID-19 vaccination will have a great role in changing the perception of pregnant women. Therefore, the government should design public health programs targeting the identified factor, and should minimize the perception of risk acquiring infection from COVID-19 vaccine to improve maternal and neonatal health outcome.