Background – Thalassemia is an inherited, serious public health problem and a cause of life threatening hemolytic anemia throughout the Mediterranean region. Due to multiple blood transfusions, iron overload-related complications appear. It can be well-managed with chelation therapy. Aims of the study: This study was conducted to assess the adherence to iron chelation therapy among transfusion dependent beta-thalassemic children and to evaluate the causes for non-compliance. Methods and Material: This cross-sectional study was conducted in thalassemia unit at a tertiary care centre in Punjab. A total of 50 thalassemia patients, who were on chelation therapy for atleast one year, were enrolled after a written consent. After receiving informed consent, patients were individually asked to fill a questionnaire consisting of personal and demographic information. Questionnaire was checked for compliance and pretested questionnaire called Morisky Medication Adherence Scale. Statistical analysis used: The data was summarized using frequency distribution and descriptive analysis. Chi square test was used to find the association of categorical variables. The P value <0.05 was considered significant. All statistical analysis was performed using SPSS version 21.0. Results: In our study 54% of the patients had compliance ≤90%. The mean ferritin was 3131.4±1271.3 μg/ml among the patients with compliance ≤90% then 2398.1±972.0 μg/ml with compliance >90%. Nearly half of the thalassemia patients on regular transfusion and chelation therapy have poor adherence to iron chelation treatment. Illiteracy, low socio economic status, female child and rural area are linked to worse adherence. Conclusions: Our study suggests that socio-economic,demographic and cultural conditions are important factors affecting adherence to chelation therapy and outcome indicators in thalassemic children. This underlines the importance of a societal commitment and a need to focus on public strategies to support families with thalassemic children.