BackgroundPreconception care is an essential reproductive health intervention aimed at reducing preventable maternal and neonatal risks. Despite its significance, utilisation in low- and middle-income settings remains low. This study examined determinants of PCC utilisation among women of reproductive age in Ghana, applying Andersen's Behavioural Model.MethodsA descriptive cross-sectional design was used, involving 464 women aged 15–49 years in the Koforidua Municipality. Data were collected through structured questionnaires and analysed with descriptive statistics, Chi-square tests, and hierarchical logistic regression using Jamovi version 2.7.23.ResultsThe study found a PCC utilisation rate of 69.4%. Younger women were less likely to use PCC, with those aged 21–25 years (AOR = 0.03; p = 0.024) to 36–40 years (AOR = 0.01; p = 0.005) showing lower odds compared with women under 20 years. Ethnicity strongly influenced utilisation, with Akan (AOR = 6.94; p < 0.001), Ewe (AOR = 5.65; p = 0.007), and Ga (AOR = 5.10; p = 0.048) women having higher odds. Women with no formal education were less likely to utilise PCC (AOR = 0.09; p = 0.049), while those receiving counselling (AOR = 5.15; p < 0.001) or exposed to radio campaigns (AOR = 3.30; p = 0.003) had increased odds.ConclusionPCC utilisation in Ghana was moderate and associated with sociodemographic, informational, and health-system factors. Strengthening provider counselling, community-based health education, and consideration of PCC within national reproductive health financing strategies may help improve uptake.