Pesticides represent a potential public health hazard of note in farming communities. Accumulating evidence indicates that some pesticides used in agriculture act as hormone disrupters, with the potential to result in chronic health effects. Despite such a growing evidence base, pesticides remain the preferred method of pest control in agriculture worldwide. In many parts of Sub-Saharan Africa, usage is on the increase. This qualitative study assessed changes in the usage of pesticides by Zimbabwean smallholder cotton farmers in the past 30 years. Farmers reported an increase in the usage of pesticides, specifically insecticides, since the early 1980s. An increase in pest populations was also reported. The findings suggested a bi-directional causal relationship between the increase in pest population and the increase in pesticide use. Factors which emerged to have collectively impacted on the changes include climate variability, limited agency on the part of farmers, power dynamics involving the government and private cotton companies and farmers' perceptions and practices. An Integrated Pest Management Policy for Zimbabwe is recommended to facilitate integration of chemical controls with a broad range of other pest control tactics. Continuous farmer education and awareness raising is further recommended, since farmers' perceptions can influence their practices.