Aim <p>Anemia during pregnancy is a pressing global health concern, affecting approximately 40% of pregnancies worldwide, with significant implications for maternal and fetal health. This study investigates the prevalence of anemia among pregnant women in rural Punjab, India, and explores associated factors impacting adherence to Iron and Folic Acid (IFA) supplementation.</p> Subjects and methods <p>A secondary data analysis was conducted on health records from 175 pregnant women in Hambran, Punjab, from January 2019 to March 2022. Demographic information and haemoglobin levels were analyzed, and sociodemographic and obstetric factors influencing anemia were assessed using statistical tests.</p> Results <p>Among 175 pregnant females the mean haemoglobin level was 9.6 ± 1.2&#xa0;g/dl; moderate anaemia was most prevalent (57.2%), followed by mild (37.1%) and severe (1.7%). Only 38.9% consumed Iron and Folic Acid (IFA) tablets regularly, with forgetfulness (35%) being the leading reason for non-compliance. Anaemia was significantly associated with employment status (<i>p</i> = 0.05) and IFA supplementation (<i>p</i> &lt; 0.001). Multinomial regression showed that non-consumption of IFA increased the odds of moderate anaemia by 12.5 times (OR = 12.49; 95% CI: 2.10–74.21; <i>p</i> = 0.01). Employment appeared protective, though associations were not statistically significant.</p> Conclusion <p>The findings reveal a critical public health issue, with high rates of anemia among pregnant women in rural Punjab. The study emphasizes the need for targeted educational interventions to enhance IFA adherence, promote female employment, and address misconceptions about anemia management. Comprehensive maternal health programs are essential to mitigate anaemia’s impact and improve outcomes for mothers and infants in resource-limited settings.</p>