Preconception care involves biomedical, behavioral and social health interventions to women and couples before conception to improve their health status, reduce 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 middle 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 uptake of PCC services have not been extensively revealed, especially in the study area. Therefore, a facility based mixed method cross sectional study design was conducted among 241women of reproductive age and 20 health care providers from September to December 2021, at Jaramogi Oginga Odinga Teaching and Referral Hospital to investigate the factors associated with the uptake of preconception care services. The study employed the use of systematic and purposive sampling techniques in selecting study participants. The information regarding the purpose of the study and the rights of participants were provided for the study participants. Written informed consent was obtained from each study participants before actual data collection. Pre-tested, semi-structured questionnaires were used to collect data. Quantitative data were coded and entered into Microsoft Office Excel 2007, then transferred into Statistical Package for Social Sciences version 22 for analysis. Descriptive statistics were used to calculate frequency and percentage of the characteristics of the participants. Pearson’s chi-square was used to find out the correlation for characteristics between users and non users of preconception care services. The resultant significant associations were further analyzed using multivariate logistic regression. The results were considered statistically significant if p-value was less than 0.05. Qualitative data was subjected to thematic analysis and results triangulated with those from quantitative analysis. Tables, figures and texts were used to present the data. The uptake of preconception care services was low, as only 7.5% of women reported to have received the services. In terms of preconception care services received; about (26.1%) of women were screened for medical conditions, (14.9%) received family planning, (10.6%) counseling on other preconception care services and only 1.7% received tetanus toxoid vaccination before conception. 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. 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.