Adherence to iron and folic acid (IFA) supplementation during the antenatal period is paramount to reducing anemia and its associated morbidities. Although several studies have been conducted across Ethiopia, their reports were inconsistent and inconclusive for intervention. Therefore, this systematic review and meta-analysis estimated the pooled national level adherence to IFA supplementation and its determinants among pregnant women in Ethiopia. Twenty studies with a total of 16,818 pregnant women were included in this meta-analysis. The pooled national level iron and folic acid supplementation’s adherence was 46.15%.