ABSTRACT Background: Many women who undergo labor induction have an unfavorable cervix. Therefore, cervical preparation by using a safe and effective method is necessary to increase the chance of successful induction. Objective: To compare the efficacy of transcervical Foley catheter and intra-vaginal misoprostol as a pre-induction cervical ripening method and associated factors at selected public hospitals of Addis Ababa, Ethiopia, 2020. Methods: A retrospective institution based cross-sectional study was conducted from October to November 2020 in selected Hospitals of Addis Ababa, Ethiopia. The consecutive sampling method was used to enroll a sample size of 204 study participants for each group of cervical ripening methods, by using delivery and induction registration books. The first group was women primed by transcervical Foley catheter and the second was those by intra-vaginal misoprostol. Data were collected by questionnaire and entered into a computer using Epi-data version 4.6.2 statistical program then it was exported to SPSS version 25 for analysis. Selected baseline characteristics and outcome measures were compared using the independent sample T-test and Fisher’s exact or Chi-Square test for continuous and categorical variables respectively. Lastly, the significance of the statistical association was assured using OR at a 95% confidence interval and p-value <0.05. Result: The rate of success of induction (χ2 = 5.892; P=0.015) and mean change in Bishop's (P<0.001) score were found to be significantly higher in the Foley catheter group. But the rate of uterine hyperstimulation (P =0.02), fetal heart rate abnormality (P=0.01), maternal and neonatal adverse effects (P=0.04), and NICU admission (P=0.01) were significantly higher in the misoprostol group. Parity (AOR=4.45(95% CI: 2.01- 9.82) and gestational age (AOR=0.45(95%CI: 0.220.90), were significant predictors of success in misoprostol group compared to residential address (AOR=0.46(95%CI: 0.26-0.95) in the Foley group. Conclusion and recommendation: This study showed that a transcervical Foley catheter increases the success rate of induction and decreases maternal and neonatal complications associated with induction of labor. The result suggested that safety issues need to be taken into consideration when misoprostol is planned to use especially in multiparous women.