Objectives: Maternal, newborn, and child health (MNCH) services represent opportunities to integrate postpartum family planning (PPFP). Objectives were to determine levels of MNCH-family planning (FP) integration and associations between integration, client characteristics, and service delivery factors in facilities that received programmatic PPFP support. Design and setting: Cross-sectional client flow assessment conducted May–July 2014, over 5 days at 10 purposively selected public sector facilities in India (four hospitals) and Kenya (two hospitals, four health centers). Participants: 2,158 client visits tracked (1,294 India; 864 Kenya). Women aged 18 or older accessing services while pregnant and/or with a child under 2 years. Interventions: PPFP/postpartum intrauterine device—Bihar, India (2012–2013); Jharkhand, India (2010–2014); Embu, Kenya (2008–2012). Maternal, infant, and young child nutrition/FP integration—Bondo, Kenya (2011–2013). Primary outcome measures: Proportion of visits where clients received integrated MNCH-FP services, client characteristics as predictors of MNCH-FP integration, and MNCH-FP integration as predictor of length of time spent at facility. Results: Levels of MNCH-FP integration varied widely across facilities (5.3% to 63.0%), as did proportion of clients receiving MNCH-FP integrated services by service area. Clients traveling 30–59 minutes were half as likely to receive integrated services versus those traveling under 30 minutes (odds ratio [OR] 0.5, 95% confidence interval [CI] 0.4–0.7, p<.001). Clients receiving MNCH-FP services (versus MNCH services only) spent an average of 10.5 minutes longer at the facility (95% CI −0.1–21.9, not statistically significant). Conclusions: Findings suggest importance of focused programmatic support for integration by MNCH service area. FP integration was highest in areas receiving specific support. Integration does not seem to impose an undue burden on clients in terms of time spent at the facility. Clients living furthest from facilities are least likely to receive integrated services.