Iron and Folic Acid (IFA) supplementation during pregnancy is a critical public health intervention aimed at preventing iron deficiency anaemia, a condition that endangers both maternal and fetal well-being. The World Health Organization (WHO) advises intermittent IFA supplementation for menstruating women in regions where anaemia prevalence is ?20%, and daily supplementation throughout pregnancy to mitigate risks such as antenatal anaemia, iron deficiency, and low birth weight. In India, the Intensified National Iron Plus Initiative (I-NIPI) recommends a daily prophylactic dose of one IFA tablet containing 60 mg of elemental iron and 500 mcg of folic acid from the fourth month of pregnancy through 180 days postpartum.

Despite these national guidelines, adherence remains a challenge. In Meghalaya, coverage under the Anaemia Mukt Bharat strategy improved from 78% to 90% between 2017 and 2020, yet actual compliance lags behind, with studies indicating adherence rates between 47% and 55%. This study evaluated the knowledge and compliance of IFA supplementation among pregnant women attending Mawroh Primary Health Centre and Mawtawar Sub-centre in East Khasi Hills, Meghalaya. Using a descriptive cross-sectional design, 120 pregnant women were recruited consecutively. Data were gathered through a structured questionnaire and the Morisky 8-item medication adherence scale, and analysed using SPSS version 27.0 with both descriptive and inferential statistics, including Chi-square and Fisher’s exact tests.

Results revealed that 80% of participants had adequate knowledge of IFA supplementation. However, adherence levels varied: 30% reported high adherence, 48.3% moderate, and 21.6% low. Knowledge was significantly associated with the place of care (P< 0.05), while compliance was influenced by gestational age, healthcare facility visited, and distance to the health center (P< 0.05).

In conclusion, while awareness of IFA supplementation was relatively high, actual compliance remained moderate. Key factors affecting adherence included accessibility to health services and the stage of pregnancy. These findings highlight the urgent need for strengthened community health education, better distribution mechanisms, and consistent antenatal follow-up to improve compliance and promote healthier maternal outcomes.