Background: Perinatal asphyxia is when the baby receives too little oxygen because of the inability of the newborn to initiate and sustain adequate respiration immediately after delivery. Despite improvements in the diagnosis and management of perinatal asphyxia, it has become a foremost cause of admission and death in neonatal units. In Ethiopia, after the Millennium Development Goal era decrement in neonatal mortality was stagnant and perinatal asphyxia is one of the leading causes of neonatal mortality. Objective: The study was tried to assess the proportion and associated factors of perinatal asphyxia among Live births in Public Health Facilities of Bahir Dar City Administration, North-West Ethiopia, 2021. Methods Institution-based cross-sectional study was employed from April 1-30/2021 in public health facilities of Bahir Dar city administration among 517 mothers of alive newborns. Pre-tested structured questionnaire interviews were used and the data was collected by systematic random sampling technique. Data were entered by using Epi data 3.1 and edited, cleaned, and analyzed using Statistical Package of Social Sciences version 25.0. Bivariate and multivariate logistic regression analyses were employed to estimate the crude and adjusted odds ratio with a confidence interval of 95% and the P-value of less than 0.05 considered statistically significant. Frequency tables, figures, and descriptive summaries were used to describe the study variables. Result: In this study, 21.7% with 95% confidence interval of 18.2% – 25.5% of the newborns had perinatal asphyxia. Mal-presentation [AOR: 4.06 (95% CI: 2.08, 7.94)], uterotonics administration [AOR: 2.78 (95% CI: 1.67, 4.62)], meconium-stained amniotic fluid [AOR: 4.55 (95% CI: 2.66, 7.80)], night time delivery [AOR: 1.91 (95% CI: 1.17, 3.13)] and preterm [AOR: 3.96 (95% CI: 1.98, 7.89)] were significantly associated with perinatal asphyxia. Conclusion and Recommendation: In the present study, the proportion of perinatal asphyxia was low. Fetal mal-presentation, uterotonics, meconium-stained amniotic fluid, delivery at night time, and preterm delivery were significantly associated with perinatal asphyxia. To mitigate focusing on early identification of risk factors like fetal mal-presentation, preterm labor/delivery, and managing them appropriately, and administering uterotonics based on indication with close supervision based on protocol. Keywords: Asphyxia, Bahir Dar University, Determinant factors, Ethiopia, Perinatal,