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 investigate the factors associated with the uptake of preconception care services 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, as well as among 20 health care providers. Quantitative data was summarized using descriptive statistics, and associations' detected using X2 test while strength of associations measured using odds ratio (p < 0.05), using statistical package of social sciences version 22. Qualitative data was subjected to thematic analysis, and results triangulated with those from quantitative analysis. The uptake of PCC services was low, as only 63 (26.1%) were screened for medical conditions, 36 (14.9%) had received family planning services, and only 4 (1.7%) had received tetanus toxoid vaccination before conception. Up to 71.8% of the women had not heard of preconception care services, a tendency that reduced with women’s increasing age. Only women’s age (X2 = 13.078; p = 0.006) and occupation (X2 = 12.357; p = 0.002) were significantly associated with screening for medical conditions before conception. The uptake of family planning services was only associated with religion (X2 = 6.473; p = 0.031). Only women’s age (X2 = 13.078; p = 0.006) and occupation (X2 = 7.027; p = 0.028) were associated with PCC counseling before conception, whereby self-employed and employed women were about 4.3 times and 3.6 times, respectively, more likely to receive PCC counseling than the unemployed women (CORS = 4.25; 95% CI: 1.33-13.63; p = 0.015) and (CORS = 3.64; 95% CI: 1.07-12.39; p = 0.039). No specific factor (p > 0.05) was associated with tetanus toxoid vaccination. The uptake of preconception care services was low, with a concomitant low level of awareness on preconception care services among women. Individual patient and healthcare related factors are associated with the uptake 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.