Ecosystem-based adaptation (EbA) is the use of biodiversity and ecosystem services as part of an overall adaptation strategy to help people adapt to the adverse effects of climate change. EbA provides an approach to sustainable development that contributes simultaneously to socio-economic development, climate adaptation and biodiversity conservation. This is because EbA considers ways to manage ecosystems so that they can provide services that reduce vulnerability and increase the resilience of socio-ecological systems to both climatic and non-climatic risks, while at the same time providing multiple socio-economic benefits to society. Owing to the multiple benefits that EbA provides, it can be of use to coastal cities and the multi-faceted systems that exist within these cities. Like coastal cities around the world, South African coastal cities are highly vulnerable to climate impacts. Durban and Cape Town, among others, are increasingly exposed to climate impacts such as flooding, rising sea levels, seawater intrusion and coastal storm surges. These cities are key economic zones that are important contributors to the national economy, thus attracting large populations (including the urban poor) that reside in coastal urban and peri-urban areas. Therefore, climate impacts will affect not only urban economies but also the livelihoods and well-being of coastal populations. As EbA benefits both nature and people, it can be used to address socio-economic and development goals. However, various barriers and challenges exist in the implementation and governance of EbA in South African coastal cities. For South Africa to reap the benefits offered by EbA, it is crucial that the challenges associated with regulation, governance and management, institutional arrangements and partnerships, knowledge, communication and engagement, and financial mechanisms are addressed, and that the opportunities related to these areas are maximised. The outcomes of this paper provide learning opportunities for African and other developing coastal cities.