Anemia during pregnancy is a worldwide problem, Iron deficiency and folate deficiency are considered as the first two causes of nutritional anemia. Many antenatal care program distributed iron and folic acid supplementation to pregnant women's the effectiveness of theses intervention in reducing maternal anemia's still has been in adequate. Some suggest that poor compliance is the probable reason for the ineffectiveness of such program. Aim of the Work: The aim of this study is to improve the adherence of pregnant women to Iron and Folic acid supple-mentation. Study Objectives: To measure the adherence (compliance) of pregnant women to iron and folic acid supplementation and prevalence of anemia in pregnant women and to study the different factors affecting the adherence to Iron and Folic acid supplementation. Material and Methods: This descriptive cross sectional study was conducted on 270 pregnant women in the second or third trimester attending El-Salam Primary Health Care center in Ismailia governorate were included in the study. study done on January, February, March 2008. Women were excluded from the study if have any of the following disorders including (Hemolytic anemia, hemoglobinopathies, mental disorders, chronic diseases, or chronic inflammatory disorders). All women were assessed for adherence to iron and folic acid supplement through self reported and pill count adherence. Hemoglobin concentration from follow-up charts was recorded. Results: According to self reported adherence; 58.9% showed no adherence and 41.1% shows adherence while concerning pill count adherence 63.3% showed no adherence and 36.7% showed adherence. Statistically significant differ-ence was found between results of self reported adherence and pill count adherence. 62.2% of the study group were anemic. Hemoglobin level ranged between 6.9-13.0g/dl, and mean ± SD were 10.5±0.7g/dl. 126/168 (75%) mild anemia, 39/168 (23,2%) moderate anemia, 3/168 (1.8%) severe anemia. Most prevalent cause of non-adherence was frustration from many tablets (75/270 pregnant women; 54.3%). When Correspondence to: Dr. Zakia M.. studying the best fitting multiple linear regression model for pill count adherence among pregnant women of study sample, it was found that age, income, pregnancy spacing, ANC visits, knowledge of folic acid and family encouragement were statistically significant independent positive predictors of pill count adherence. Conversely, crowding index, gravidity, and side effects occurrence were statistically significant indepen-dent negative predictors of pill count adherence. The model explains 24% of the variation of pill count adherence, as indicated by the value of r-square. Conclusion: Pill count is more accurate method for esti-mation of adherence to iron and folic acid supplement than self reported adherence. Age, income, pregnancy spacing, ANC visits, knowledge of folic acid and family encouragement were statistically significant independent positive predictors. Conversely, crowding index, gravidity, and side effects occur-rence were statistically significant independent negative predictors.