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Background: High-risk fertility behavior (HRFB) is a serious public health issue that may influence the country's economic development as well as the health status of mothers mainly in developing countries, like Ethiopia.However, there is a scarcity of evidence about HRFB and associated factors in the study area. Therefore, this study assessed HRFB and associated factors among mothers attending antenatal care in public health facilities in Hossana town, Hadiya zone, Central Ethiopia Region. Methods: A facility-based cross-sectional study was conducted among 276 women who were attending antenatal care follow-up by using a systematic sampling technique from July 01 to 30, 2023. Data were collected through face-to-face interviews. Data entry was done by Epi data version 4.6 and analysis was done by SPSS 25 statistical software. Variables with p-value < 0.25 in bi-variable analysis were moved to multivariable analysis for controlling the possible confounders. In the multivariable analysis, variables with p-values less than 0.05 and a 95% confidence interval were considered statistically significant to HRFB. Results: In the study, it was found that 67.39% of the total participants, specifically women, exhibited high-risk fertility behavior (HRFB) (95% CI: 63.91, 71.01). Among these, 41.90% were identified as having a single high-risk factor (95% CI: 39.78, 44.2), while 25.47% were classified as facing multiple high-risk factors (95% CI: 24.13, 26.8). The research indicated that several factors significantly contributed to maternal HRFB, including lack of antenatal care (ANC) follow-up (AOR: 3.36, 95% CI: 1.78, 6.35), having fewer than four ANC visits (AOR: 2.44, 95% CI: 1.38, 4.32), and a poor knowledge of contraceptives (AOR: 2.89, 95% CI: 1.02, 5.11). Conclusion: The findings of this study showed that HRFB is high. Almost two out of three women experience HRFB. Having ANC follows- up, number of ANC visits, and knowledge on contraception were the major factors affecting HRFB. HRFB could seriously indicate the development of the country as well as maternal health issues. Therefore, Health education on advantages of ANC follow up and contraceptive use should get due attention. [ABSTRACT FROM AUTHOR]