Background: The correct development of the embryo is contingent upon the consumption of folic acid prior to conception. The utilization of picture-based education is an exceptional method for enhancing the awareness and compliance of women with iron-folic acid supplementation. Aim: The current study aimed to examine the effect of preconception picture-based educational program on awareness and adherence to iron-folic acid supplements among women planning for pregnancy.  Design: A quasi-experimental research design (Two-Groups, study and control) was used to attain the aim this research. Study Setting: This research was conducted at family planning clinic and Obstetrics & Gynecological ward affiliated to Benha University Hospitals in Qaliobya governorate, Egypt. Sample: A purposive sample, of 230 women (divided equally into study and control group) planning to get pregnancy were recruited according to inclusion and exclusion criteria. Tools: Six main instruments were used: a structured self-administered questionnaire, women's knowledge questionnaire, women's attitude questionnaire, women's adherence assessment sheet, barriers for adherence to the iron-folic acid supplementation intake and visual analog satisfaction scale Results: there was a high statistically significant difference between study and control group women relating to knowledge, attitude adherence and barrier to iron-folic acid supplementation. after implementation of picture-based education program. Moreover, more than two-thirds of women in study group were highly satisfied with intervention. In both groups, there was a statistically significant positive correlation between the total knowledge score and the total (attitude and adherence) scores during the pre- and post-intervention phases. Conclusion: Preconception picture-based educational program had desirable effect in enhancing women's awareness (knowledge and attitude), exhibiting better adherence to iron-folic acid supplementation with lower barriers, improving Hemoglobin level, and attaining high satisfaction; which reflected approval of the research hypotheses. Recommendations: A preconception picture-based educational program should be disseminated in all maternity hospitals to enhance the knowledge, attitude, and adherence of women attending outpatient clinics to preconception iron-folic acid.