Objective To assess the preparedness of public health care facilities to provide essential newborn care across India Design Mixed methods study analysing the collected cross sectional observational data across five districts of India. Setting India, across districts of Thiruvallur, Cuttack, Allahabad, Vadodara and Jaipur Sample 56 healthcare facilities comprising of Medical colleges, District/Sub-district hospitals, and Community Health Centres/First Referral Units and Primary Healthcare units. 1479 women undergoing vaginal delivery and qualitative data on attitude and barriers faced while following mandated guidelines of essential newborn care were collected from 125 healthcare providers. Method Descriptive analysis for the quantitative data and inductive and deductive analysis for the qualitative data Main outcome measure Preparedness of different facilities was considered as a composite of four dimensions- Clean delivery, Clean cord care, Optimal thermal care and Early exclusive breastfeeding. Results Provision of hygienic delivery (50.8%) and optimal thermal care (26.1%) was observed to be highest among the women availing services in Medical Colleges and clean cord care was highest in PHCs (52.9%). Nearly 77% of cases in CHCs/FRUs experienced exclusive breast feeding. Pre-lacteal feeding, immediate cord clamping and application of traditional dressing on cord stump were prevalent undesirable neonatal care practices. Conclusion Deviations from the mandated essential newborn care protocols by a noteworthy proportion of healthcare professionals including at teaching Medical colleges was observed. Unavailability of sufficient medical supplies for safe and hygienic newborn care in addition to the need for training for essential newborn care was observed.