Background: Though women comprise a large proportion of a given society, still many of them in developing countries are at a greater disadvantage in terms of high maternal morbidity and mortality. A large number of women are dying due to factors related to pregnancy and childbirth in these countries. Objective: This study assessed safe delivery services utilization and associated factors among mothers who gave birth during five years preceding a survey conducted in North Gondar Administrative Zone, Amhara Regional State. Method: A community-based cross-sectional comparative survey was conducted in November and December 2002. A total of 1,242 women who had at least one live birth in the five years preceding the survey were selected randomly. Results: The study revealed that a total of 13.5% of mothers gave birth to their last babies in health facilities. Only about 25 of the rural women gave birth in the health institutions. Untrained traditional birth attendants and relatives attended 76.4% of the deliveries. The reported reasons were: absence of health problems, short duration of labor, preferring the attention of relatives and trust in traditional birth attendants. Educational status of the mothers, place of residence, access to radio, monthly income, prenatal care, history of intrapartum complications and other selected obstetric behaviors of the respondents showed statistically significant association with the utilization of safe delivery services (p<0.05, for each factor). Conclusion: In general, this study revealed that the proportion of births delivered in health facilities is low in the area. Demographic and socio-cultural factors were found to be barriers to the utilization of safe delivery services. Enhancing the establishment of more emergency obstetric care centers within reasonable access, providing Information, Education and Communication (IEC) on maternity services utilization and harmful traditional practices and improving the status of women in the community are recommended.