Modeling studies estimated severe impacts of potential service delivery disruptions due to the COVID-19 pandemic on maternal and child nutrition outcomes. Although anecdotal evidence exists on disruptions, little was known about the actual state of service delivery at scale. Alive & Thrive studied disruptions and restorations, challenges and adaptations in health and nutrition service delivery by frontline workers in India during COVID-19 in 2020. This article details the results of this study.