SETTING: All public health facilities in Rwanda, East Africa. OBJECTIVE: To assess the change in the utilization of maternal and child health (MCH) services during the COVID-19 outbreak. DESIGN: This was a cross-sectional quantitative study. RESULTS: During the COVID-19 outbreak in Rwanda, the utilization of 15 MCH services in all four categories-antenatal care (ANC), deliveries, postnatal care (PNC) and vaccinations-significantly declined. The Northern and Western Provinces were affected the most, with significant decrease in respectively nine and 12 services. The Eastern Province showed no statistically significant utilization changes. Kigali was the only province with significant increase in the fourth PNC visits for babies and mothers, while the Southern Province showed significant increase in utilization of measles + rubella (MR) 1 vaccination. CONCLUSION: Access and utilization of basic MCH services were considerably affected during the COVID-19 outbreak in Rwanda. This study highlighted the need for pre-emptive measures to avoid disruptions in MCH service delivery and routine health services during outbreaks. In order for the reductions in MCH service utilization to be reversed, targeted resources and active promotion of ANC, institutional deliveries and vaccinations need to be prioritized. Further studies on long-term impact and geographical variations are needed.