Preconception care involves the provision of health interventions to women and couples before conception and aims at improving their health status, reducing behaviors, individual and environmental factors that contribute to poor maternal and child health outcomes. It has potential to further reduce global maternal and child mortality and morbidity, especially in low-income countries where the highest burden of pregnancy-related deaths and disability occurs. Most often, preconception care is rarely delivered to women, and it is often ignored or minimized by both the patient and the provider. The factors contributing to the low uptake have not been extensively revealed, especially in the study region. The main objective of this study was to assess the uptake of preconception care services and associated factors among women of reproductive age at Jaramogi Oginga Odinga Teaching and Referral Hospital. A total of 241 women sampled by systematic random methods answered structured questionnaires, while 20 health care providers served as key informants. Quantitative data was summarized using descriptive statistics, and associations detected by chi-square test. Data findings were then presented using tables, graphs and pie charts. Qualitative data was subjected to content analysis, and themes derived, which were used to triangulate the quantitative results. All statistical analysis was done using SPSS v. 22. The uptake of preconception care services was low (65.8%), and majority were unaware of these services being at the facility. There was low level of knowledge on preconception care services (71.8%), although majority (45.4%) preferred the hospital as the source of information. The factors influencing the utilization of preconception care services included patient-related factors like chronic diseases, and cultural beliefs and practices, as well as health care provider-related factors like staff shortage, inadequate supplies and resources. There was a significant association between the level of knowledge on preconception care and the age of the woman (p=0.0001), marital status (p=0.01), educational level (p=0.002), and occupation (p=0.001). The uptake of preconception care services was low, with a concomitant low level of knowledge on preconception care services among women. Individual patient and healthcare related factors influence the utilization of preconception care services. The study recommends that the Ministry of Health should ensure the availability of adequate elements of preconception care, while prioritizing public health education on preconception care, empowering the healthcare providers, and involving stakeholders, so as to achieve a robust uptake.