Russian synchronized swimmers won this event for the sixth time in a row, with Svetlana Romashina becoming a six-time Olympic champion.

The scores from the two routines were added together and the top twelve duets qualified for the final.

Both preliminary free and technical routines starting lists were decided by random draw.

The 3 panels for the free routine consider execution (30% of score), artistic impression (40%), and difficulty (30%).

The 10 National Olympic Committees (NOC) qualified for the team competition were automatically awarded a place for duets.

Each continent also received one dedicated duet place; Africa, Asia, and Oceania used the 2019 World Aquatics Championships to determine their selections, while the 2019 Pan American Games and the 2019 European Champions Cup served as qualifiers for the Americas and Europe.