Introduction: iron and folate supplementation can effectively control and prevent anaemia in pregnancy. In Ethiopia, all pregnant women are prescribed iron folate during their ANC visit. However, limited adherence is thought to be a major reason for the low effectiveness of iron supplementation programs. Therefore this study was done to investigate factors associated with compliance of prenatal iron folate supplementation among women who gave birth in the last 12 months before the survey in Mecha district.

Methods: Community based cross sectional study design was employed in Mecha district from June 25 - July 15/2013. A sample of 634 women who gave birth 12 months before the survey was included in the study. Study participants were selected by systematic random sampling technique. Data were collected using a pre-tested structured Amharic questionnaire. Collected data were edited, coded and entered to Epi info version 3.1 and exported to` SPSS version 16. Bivariate and multivariable analysis was computed.

Results: a total of 628 women who gave birth twelve months before the survey were enrolled. In this study, only 20.4% of participants were compliant with iron foliate supplementation. In multivariable analysis, age of the mother, educational status of the mother, knowledge of anaemia and iron folate tablets, and history of anaemia during pregnancy were significantly associated with compliance to iron folate supplementation (P < .05). Belief that too many tablets would harm the baby and fear of side effects were the major reasons given for noncompliance.

Conclusion: compliance to iron folate supplementation is very low in the study area. Increasing female education and improving women’s knowledge of anemia and iron folate tablets are recommended to increase compliance to iron folate supplementation.