Minimum tillage combined with mulching (MTM) is critical to conservation agriculture, yet its use by smallholder farmers raises challenging questions regarding adoption, diffusion and scaling at farm level. In this paper, we used probit regression and post-estimation simulations to identify the key micro (farm specific) and macro (country specific) factors as predictors of MTM adoption in four countries spanning a north-south gradient in eastern and southern Africa (ESA): Ethiopia, Kenya, Tanzania and Malawi. We found that farmers’ access to markets and social capital empirically predicted MTM adoption. Policies that increased fertilizer subsidies and extension-staff-to-farmer ratios had similar effects, even if only modestly. Conceivably, subsidies specifically targeted at MTM could also be considered based on their potential environmental and social benefits. We conclude that adoption of MTM still faces the same micro- and macro-level hurdles common to all agricultural technologies. Long-term investments in agricultural extension and reductions in the costs of complementary inputs are critical for the diffusion of MTM.