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Desalegn Tesfa,1 Wallelign Aleminew,2 Melaku Tadege,1 Alemayehu Digssie,1 Bedilu Abebe,1 Sofonyas Abebaw,1 Belayneh Kefale3 1Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia; 2Department of Health Education, University of Gondar, Gondar, Ethiopia; 3Department of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, EthiopiaCorrespondence: Desalegn Tesfa Department of Public HealthCollege of Health Sciences, Debre Tabor University, P.O. Box 031, Debre Tabor, EthiopiaTel +251-918027124Email desalegntesfa50@gmail.comBackground: Happiness is the most indicator of good quality of life particularly for pregnant women. Reduced happiness of pregnant women can result in reduced maternal health services utilization and can result in adverse newborn and maternal outcomes. Assessing the level of happiness and its factors are important for pregnant women and the next generation. Hence, the current research paper aimed to assess the level of happiness and its associated factors among pregnant women who attended antenatal care follow-up in South Gondar Zone Hospitals.Methods: Institution-based cross-sectional study was carried out from September 2018 to February 2019 among 1606 expectant pregnant women in the last 6 months. The Oxford Happiness Questionnaire (OHQ) was used as a measure of the degree of happiness and used four as average person score. Besides, bivariate, multivariable logistic analyses were deployed to identify associations.Results: A total of 1606 pregnant women were participating in this study. The prevalence of low level of pregnancy happiness in this study was 24% (95% CI: 20.7 − 26.6). Mothers who exposed to unintended pregnancy (AOR; 1.94, CI 95% 1.86– 4.52), reported intimate partner violence (AOR; 2.42, 95% CI 1.67– 3.54) and being in the third trimester (AOR; 1.89 95% CI 1.19– 3.01) were the most predictor variables with the low level of happiness.Conclusion: Approximately one-fourth of the pregnant women had a low level of pregnancy happiness. Mothers who were exposed to unintended pregnancy encountered intimate partner violence, who were in the third trimester were the most significant variables associated with a low level of happiness. Governmental and non-governmental organizations work on women’s reproduction rights and the zonal health department with local health offices should educate on the prevention of intimate partner violence and unintended pregnancy and its consequences and also empower women to cope with changes and challenges of pregnancy and childbirth.Keywords: happiness, pregnancy, women, level, associated factors