This study examines levels and trends in two dimensions of newborn care quality—service availability and service readiness—in Bangladesh, Haiti, Malawi, Senegal, and Tanzania, the five USAID maternal and child health (MCH) priority countries with Service Provision Assessment (SPA) surveys conducted since 2011. In each country, key services, commodities, and medicines needed for comprehensive delivery and newborn care were missing from a large proportion of facilities that offer normal delivery services. Of the three domains of service availability examined, scores for routine care availability are consistently highest, and scores for newborn signal function availability are lowest. Of the four domains of service readiness examined, scores for general requirements and equipment are consistently highest, while scores for guidelines and staffing are lowest. Both service availability and service readiness tend to be highest in hospitals and in urban areas, pointing to substantial equity gaps in the quality of newborn care. In Tanzania, where two SPA surveys were conducted recently, in 2006 and 2014-15, all measurable domains of newborn care service availability and readiness showed significant improvement between surveys, and urban-rural and public-private quality gaps narrowed. In conclusion, we found some encouraging evidence of newborn care service availability and readiness among the countries studied, but we also identified a great deal of room for improvement. The findings indicate the need for broad initiatives that improve staff competence, address systemic barriers to service provision, and promote equity in newborn care quality.