Background: The COVID-19pandemic emerged as a major public health crisis, which has affected all dimensions of the health care system. Sexual and reproductive health services were severely affected, leading to a decrease in access and service utilization, affecting the overall health of women.Methods: A two-year comparative study, before and during the COVID-19 pandemic, on safe abortion services and family planning, was conducted at Paropakar maternity and women's hospital to assess the impact of COVID-19 on service utilization.Results: Safe abortion services were decreased by 34.4%, and family planning services by 39%, in 2020 as compared to the previous year. Uptake of long-acting reversible contraceptives and permanent methods was most affected. Utilization of services was affected markedly during lockdown, and showed a persistent decline, even after the lockdown was lifted.Conclusions: The COVID-19 pandemic has seriously affected safe abortion and family planning services in Nepal due to lockdown, travel restriction, home isolation, resource reallocation, health facilities serving only emergencies and confusing messages about COVID-19 control. The decline in these services will create additional demand and pressure on the health care system, resulting from unplanned pregnancies and unsafe abortions. Health care staffs should be reoriented about the essential nature of safe abortion and family planning services during emergencies, and the implications of service disruption, on society and the country. Pragmatic and gender sensitive changes to national policies should be made, to ensure that women's health is safeguarded, and safe abortion and family planning included as essential health care services during emergencies.