Objective: The authors evaluated factors contributing to coronavirus disease 2019 (COVID‐19) vaccine hesitancy among pregnant and postpartum women to inform vaccine scale‐up strategies. Methods: This observational study utilized data from pregnant and postpartum women attending four public maternal child health (MCH) clinics in Western Kenya. From October 2020 to July 2022, nurses assessed COVID‐19 vaccine hesitancy, defined as reporting "unlikely" or "very unlikely" to the question, "If a vaccine for COVID‐19 were available today, what is the likelihood that you would get vaccinated?" Results: Among 1023 women (235 pregnant, 788 postpartum), 20% reported worsened MCH care during the pandemic and most (92%) perceived themselves or family members to be at risk for COVID‐19, yet 54% of women reported COVID‐19 vaccine hesitancy. Vaccine hesitancy was more frequent among women reporting worsened MCH care (P < 0.001) since the pandemic and those who did not trust the government as a source of COVID‐19 information (P = 0.016). Over the 2‐year period, willingness to receive the vaccine almost doubled (38% to 71%, P < 0.001). Conclusions: Our findings suggest that sustaining access to quality MCH services may decrease COVID‐19 vaccine hesitancy. Willingness to receive the vaccine doubled over the 2‐year period in our cohort, suggesting increased trust for use and acceptance in the unique context of the pregnancy/postpartum period. Synopsis: Among Kenyan pregnant and postpartum women, COVID‐19 vaccine hesitancy was high and less frequent among those reporting no change in healthcare quality during the pandemic. [ABSTRACT FROM AUTHOR]