Objectives: Under 5 years old (under-5) anemia is overlooked despite its detrimental effect.The approach to anemia prevention has been extended to maternal pre-pregnancy phase. This research is aimed to analyze pre-pregnancy anemia association and risk of anemia in under-5 children.Methods: This cohort study observed non-pregnant women in the Indonesian Family Life Survey (IFLS) 2007 and their under-5 children in the IFLS 2014. Anemia status was determined based on Hemoglobin (Hb) measurement using Hemocue TM in mothers and children. Mantel-Haenszel adjusted relative risk (aRR) analysis including risk stratification by the covariates was used to get final risk assessment.Results: A total of 637 under-5 children in the IFLS 2014 were included. The risk of having under-5 child with anemia increased 1.71-fold in women with pre-pregnancy anemia compared to women without pre-pregnancy anemia (aRR=1.71, 1.03-2.85 95% CI). After risk stratification based on the potential confounding variables, maternal pre-pregnancy anemia is still an independent risk of under-5 anemia in child that still breastfed at the time of data collection (RR=2.11, 1.16-3.86 95% CI), in child that fed water earlier than 6 months old (RR=2.08, 1.20-3.61 95% CI), in child of mother with normal and underweight pre-pregnancy BMI (RR=1.94, 1.20-3.14 95% CI), and in child of mother with no current anemia (RR=2.20, 1.21-3.99 95% CI).Conclusions: Pre-pregnancy anemia increased the risk of under-5 anemia based on Indonesian population study. Public health approach to extend maternal health provision to preconception phase would provide better maternal and child morbidity risk prevention.