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Objective To investigate geographical inequalities and changes in the quality of emergency obstetric care services available in Haiti over time. Methods We utilized data from the Service Provision Assessment survey of all health facilities in Haiti in 2013 and 2017.We developed a quality index for basic emergency obstetric care (BEmOC) and comprehensive emergency obstetric care (CEmOC) based on the items in the signal functions of an emergency obstetric care framework, using a structure, process and outcome framework. We measured the quality index of all facilities in 2013 and 2017. We also assessed geographical trends and changes in quality between 2013 and 2017 using geospatial analysis. Result Our analysis showed that basic structure items such as connection to electricity grid, manual vacuum extractors, vacuum aspirators and dilation and curettage kits were widely unavailable at healthcare facilities. There was a significant improvement in indicators of structure (P <  0.001) and BEmOC (P   =  0.03) in primary facilities; however, there was no significant change in the quality of CEmOC in primary facilities (P =  0.18). Similarly, there was no significant change in any of the structure or process indicators at secondary care facilities. Conclusion The availability of BEmOC at several Haitian facilities remains poor; however, there was significant improvement at primary care facilities, with little to no change in overall quality at secondary health facilities. [ABSTRACT FROM AUTHOR]