Background: Iron deficiency anemia is the most common medical complication during pregnancy. Adherence to iron is one of the determinant factors to prevent anemia during pregnancy. Studies done in different parts of Ethiopia shows wide discrepancies as to the adherence of iron and folic acid. This study provides local information about the problem. Objective: To assess rate of adherence and associated factors for iron-folic acid supplementation among pregnant mothers at Felege Hiwot comprehensive specialized hospital Methods: Facility based cross sectional study was conducted on 416 women who had attended ANC follow up at Felege Hiwot Compressive Specialized Hospital from April 1, 2019 to August 30, 2019. Study participants were selected with systematic random sampling .Checklist and structured questionnaire was used to retrieve information from the mother and her medical document. Data coded and entered into EPI- Info 7 and then exported in to SPSS 23 for analysis, both Bivariate and multivariable Logistic regression with odds ratios along with the 95% confidence interval was computed and interpreted accordingly. A P-value <0.05 was declared as statistically significant. The results presented in tables and charts. Result: About 263 (67.4%) were adherent to iron and folic acid supplementation. Counseling (AOR=2.30,95%CI=1.21-4.34), knowledge (AOR= 4.22,95%CI 2.43- 7.31), Number of antenatal care visits(AOR=3.50,95%CI=1.55-7.92) , and having follow up in tertiary facility (AOR=2.61,95CI%=1.52-4.50), were associated with iron-folic acid adherence. Having history of hypertension results threefold reduction in adherence (AOR=3.07, 95 CI=1.37-6.89). Conclusion and Recommendations: Adherence rate is better in this study as compared to most other studies in the country. Counseling, knowledge, Number of visits, and having antenatal care follow up in tertiary facility, were associated with iron-folic acid supplementation adherence. Counseling has to be a routine job at the antenatal care clinic for better adherence to address misconceptions regarding iron and folic acid supplementation. Key words: Adherence, iron-folic acid