Background: Obstetric fistula is a devastating childbirth injury, and a neglected public health and human right concerns. A pivotal strategy to mitigate the incidence of obstetric fistula is prevention and action starts with knowledge. In Ethiopia, different scholars due emphasized on knowledge towards obstetric fistula however, there is high discrepancy between urban and rural reproductive-age women. Objective: To compare knowledge towards obstetric fistula and its associated factors among married reproductive-age group women in Takussa Woreda, Northwest Ethiopia, 2020. Method: A community-based comparative cross-sectional study was employed from February 20 to March 20, 2020 among 978 reproductive-age women in Takussa Woreda. Systematic random sampling technique was used to select study participants. Data were collected by using a structured pre-tested interviewer-administered questionnaire. Binary logistic regression model was fitted to identify associated factors. Both descriptive and analytical analyses were computed. Odds Ratio with 95% CI or P-value < 0.05 was declared as statistically significance. Results: Knowledge on obstetric fistula was higher among urban women 41% with 95%CI (37%, 46%) compared with rural women 30% with 95%CI (26%, 34%). Women who attended formal education (AOR =3, 95%CI = 1.5, 6.1) and exposed to mass media (AOR =5.4, 95%CI =3.0, 9.8) had higher odds of knowledge on obstetric fistula for urban women. Whereas women whose age group 15-24 years (AOR =2.3, 95%CI = 1.01, 5.3), those who attended formal education (AOR =3.5, 95%CI =1.6, 7.9), rich wealth quintile (AOR=6.4, 95%CI =3.2, 13) and media exposure (AOR=2.8, 95%CI =1.6, 4.7) had higher odds of knowledge on obstetric fistula among rural women. Conclusion: Knowledge on obstetric fistula was high among urban than rural women. Women educational status and media exposure had a pivotal role in determining the obstetric knowledge for both urban and rural women. Moreover, age, husband occupational status, and wealth index of the household were significantly associated with obstetric knowledge of the rural women. To give information about obstetric fistula and enhances to used mass media communication to the communities was recommended. Key words: Knowledge, Obstetric fistula, urban and rural, Takussa Woreda, Ethiopia