Background <p>Utilization of maternal health services is crucial for preventing pregnancy-related complications and reducing maternal and infant mortality. This study examines how the COVID-19 pandemic affected maternal health service utilization in Buldhana district of Maharashtra, India.</p> Methods <p>A descriptive thematic content analysis was conducted using qualitative research method, through in-depth interviews (IDIs) and focus group discussions (FGDs) with 80 participants across 21 villages in Buldhana district. The study focused on pregnant lactating women and health services providers exploring their lived experiences during the pandemic and identifying strategies to strengthen maternal health service delivery.</p> Results <p>The study highlight multiple barriers to institutional delivery and maternal health service utilization. Key challenges included fear of caesarean delivery among family members, dissatisfaction with healthcare providers’ behaviour, entrenched community beliefs, poor communication, high costs of institutional deliveries, long distances to health facilities, inadequate drug availability, and poor infrastructure in health centres. During the COVID-19 pandemic, heightened fear of infection, mistrust in healthcare providers, increased psychological stress and anxiety further reduced women’s likelihood of seeking essential maternal health services. Substandard quality of care and continued reliance on traditional birth attendants (TBAs) further contributed to low service uptake.</p> Conclusion <p>Maternal health service utilization declined during the COVID-19 pandemic in the study area. Addressing both demand- and supply-side barriers particularly within the public health system is essential to improving access and utilization of maternal healthcare services.</p>