Introduction: Perineal tear is a common complication of vaginal delivery. Worldwide, more than fifty percent of women experience different degrees of perineal tear during childbirth. There are a limited data on the proportion and associated factors of perineal tear in Ethiopia. Therefore, the aim of this study was to evaluate the proportion of high-grade perineal tear and factors associated with the occurrence. Objective: The aim of this study was to assess the proportion of high-grade perineal tear and associated factors among mothers who gave birth vaginally at Habru Woreda public health institutions, Amhara region, Northeast Ethiopia, 2022 Methods: A Facility based cross-sectional study was conducted in Habru Woreda Selected public health institutions from August 1 to September 25/2022 among 600 women. Multi stage sampling technique was employed. Data were collected by face to face interviewer administered questioners, observation, clinical examination and patient chart review. The data were coded and entered into Epi-data version 4.6, and then it would be exported to statistical package for social science version 26 for analysis. Descriptive analysis was done. Binary logistic regressions analysis was done to identify statistically significant variables. Adjusted odds ratio with 95% Confidence interval was used to declare statistically significant variables on the basis of p < 0.05 in the multivariable logistic regression model. Results: The proportion of high-grade perineal tear was 3.0% with 95% CI (1.7-4.3). Factors significantly associated with high-grade perineal tear were having Antenatal Care (AOR, 0.13, 95% CI, 0.03-0.47), fundal pressure (AOR, 4.71, 95% CI, 1.29-17.10), having perineal support (AOR 0.12, 95% CI; 0.03-0.43), head circumference>=36cm (AOR, 4.81, 95% CI, 1.39-16.65), and age at marriage <18 years (AOR, 4.25, 95% CI, 1.11-16.24). Conclusion and Recommendation: The proportion of high-grade perineal tear was low. The associated factors for high-grade perineal tear were fundal pressure, head circumference>=36cm and age at marriage <18 years, while having antenatal follow up and perineal support were protective factors. We recommend working hard in reducing perineal tear by supporting perineum, avoiding fundal pressure, early detecting of big foetal head circumference with ultrasound, avoiding of early marriage and encouraging regular antenatal follow up. Keywords: Proportion, High-grade Perineal tear, Habru Woreda, Mothers 1. INTRODUCTION