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Introduction Over 60% of unplanned pregnancies end up in abortion and an estimated 45% of these abortions are unsafe, contributing for 13% of all maternal death globally. This study aimed to determine the prevalence and factors associated with unsafe abortion among married women admitted to the gynecological ward at Lira Regional Referral Hospital, a public facility in Lira City, Northern Uganda. Methodology We conducted a cross-sectional study among married women admitted with abortion to the gynecological ward at Lira Regional Referral Hospital, Lira City, Northern Uganda from December 2022 to April 2023. We used a consecutive sampling technique to recruit 368 participants. We collected quantitative data using an interviewer-administered questionnaire, and we analyzed descriptive statistics using Statistical Package for Social Sciences version 29.0. We obtained ethical approval from the Gulu University Research Ethics Committee and Lira Regional Referral Hospital’s administration. We gained informed consent from the study participants. Results 203 (55.2%) of the respondents were aged 15–24 years, 160 (43.5%) were from a rural setting, 158 (42.9%) were Protestants by religion, 338 (91.8%) were Lango by tribe, 111 (30.2%) were peasants, and 229 (62.2%) had primary level of education. 176 (47.8%) respondents had unsafe abortions, while 192 (52.2%) had safe abortions. Respondents who were aged 15–24 years were less likely to have unsafe abortion (AOR: 0.685, 95% CI: 0.454–0.725, P  = 0.020) compared to respondents aged > 34 years. Respondents who were from rural settings were more likely to have unsafe abortion AOR: 2.559, 95% CI: 1.453–4.505, P  = 0.001) compared to those who were urban settings. Respondents who had monthly income of < 100,000 shillings (AOR: 2.677, 95% CI: 1.426–5.023, P  = 0.002), 100,000–250,000 shillings (AOR: 2.854, 95% CI: 1.463–5.567, P  = 0.002), and 250,000–500,000 shillings (AOR: 2.306, 95% CI: 1.031–5.158, P  = 0.042) were more likely to have unsafe abortions compared to those who had total monthly income of > 500,000 shillings. Conclusions There was a high prevalence of unsafe abortion in this study. Older age, coming from rural settings, and low monthly income were significantly associated with unsafe abortion practices. The Ministry of Health should launch a national campaign to educate the public about the risks of unsafe abortion and the availability of sexual and reproductive health services, such as family planning services, to prevent unsafe abortion from unplanned pregnancies.