Preconception care (PCC) is the care provided to all male and female who have not conceived before, whether planning or not to have a baby for they are potential parents. It is also the care given to women who have had a child and planning to get more (inter- conception care). The aim for PCC is to decrease the danger of poor pregnancy outcomes and poor health for women, foetus, and neonates. Healthy mothers and children is the wish of every individual, family, country and Nation. Nobody wishes have a sick mother or child, yet most mothers are still suffering adverse health conditions caused by poor pregnancy outcomes in Kenya. Thus, the aim of this study was to find out factors that are associated with preconception care utilization among women in Kapsabet referral hospital in Nandi County, Kenya. A cross-sectional study design was used with a target of population of about 24,000 women in Nandi County. Data was collected from 200 women participants using a validated questionnaire. The zero-inflation Poisson regression analysis was employed to explore the factors associated with utilization of preconception care using the ‘zip’ command in STATA version 13.1. The unadjusted and adjusted incidence rate ratios (IRRs) and the 95% confidence intervals (CIs) were then presented in the tables for further interpretation. After adjusting for all variables, the study found the following variables to be associated with utilization of preconception care among women: marital status, religion, family size, ethnicity, residence, education, pesticide use, alcohol use, previous delivery, having ever lost pregnancy, and the number of current pregnancy. Those who were SDAs (IRR = 1.52; 95% CI: 1.31 – 1.76; p ≤ 0.001), had more than 4 household members (IRR = 1.24; 95% CI: 1.11 – 1.39; p ≤ 0.001), had tertiary education (IRR = 1.42; 95% CI: 1.20 – 1.67; p ≤ 0.001), were using pesticides (IRR = 2.22; 95% CI: 2.00 – 2.46; p ≤ 0.001) and were in their fourth pregnancy (IRR = 1.42; 95% CI: 1.16 – 1.73; p ≤ 0.001) were more likely to use PCC than the reference groups. In conclusion, several variable were associated with the utilization of PCC. However, there were some factors that were associated with low utilization of preconception care including the married, non-local tribes, those residing in rural areas, and those who were drinking alcohol, had previously delivered and lost pregnancy. Public health education and promotion is therefore necessary to improve maternal, newborn and child health in the county.