• Jennifer Prince Kingsley, Paul Kingsley Vijay, Jacob Kumaresan, and Nalini Sathiakumar.
• Department of Epidemiology, University of Alabama at Birmingham, Birmingham, USA. jennypk@uab.edu.
• Matern Child Health J. 2021 Jan 1; 25 (1): 15-21.

PurposeTo advocate perspectives to strengthen existing healthcare systems to prioritize maternal health services amidst and beyond the COVID-19 pandemic in low- and middle income countries.DescriptionCOVID-19 directly affects pregnant women causing more severe disease and adverse pregnancy outcomes. The indirect effects due to the monumental COVID-19 response are much worse, increasing maternal and neonatal mortality.AssessmentAmidst COVID-19, governments must balance effective COVID-19 response measures while continuing delivery of essential health services. Using the World Health Organization's operational guidelines as a base, countries must conduct contextualized analyses to tailor their operations. Evidence based information on different services and comparative cost-benefits will help decisions on trade-offs. Situational analyses identifying extent and reasons for service disruptions and estimates of impacts using modelling techniques will guide prioritization of services. Ensuring adequate supplies, maintaining core interventions, expanding non-physician workforce and deploying telehealth are some adaptive measures to optimize care. Beyond the COVID-19 pandemic, governments must reinvest in maternal and child health by building more resilient maternal health services supported by political commitment and multisectoral engagement, and with assistance from international partners.ConclusionsMulti-sectoral investments providing high-quality care that ensures continuity and available to all segments of the population are needed. A robust primary healthcare system linked to specialist care and accessible to all segments of the population including marginalized subgroups is of paramount importance. Systematic approaches to digital health care solutions to bridge gaps in service is imperative. Future pandemic preparedness programs must include action plans for resilient maternal health services.

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