Aquaculture provides more than half of the fish used for human consumption, contributing to food security and nutrition, economic growth and improved livelihoods. Aquaculture production in countries bordering the Mediterranean and Black Sea has grown steadily, though not homogenously, mainly based on marine species. To boost development, there is a need to support governance to establish activities within a coordinated spatial planning process. Knowledge of aquaculture spatial planning processes are assessed through consultations with stakeholders from 21 countries using a structured questionnaire, internal review and a workshop to determine major barriers to the implementation in the region. Results suggest different levels of knowledge of regulatory systems in the countries surveyed. Aquaculture zoning is widespread. Site selection is a long and inefficient process, a barrier to investment, exacerbated by an apparent lack of a clear distribution of power and responsibilities. Area management is the least implemented part of the spatial planning process, with few examples of an integrated approach. Poor social acceptance of aquaculture, low technical knowledge and understanding of spatial planning concepts, and a lack of meaningful communication are among the problems highlighted by stakeholders. Although recent advances are evident, the integration of aquaculture with other users of marine space remains a work in progress that requires a specific regulatory framework, capacity building, transparency, good communication and participatory processes. Application of spatial planning following an ecosystem approach to aquaculture can contribute to improvements that have the potential to counter the negative externalities of unplanned or uncoordinated development.