This study assesses the use of pesticides and the attitude to pest management strategies among rice and rice-fish farmers in the Can Tho and Tien Giang provinces in Vietnam. Interviews were made with 80 farmers. The farmers were divided in to farmers cultivating only rice with a high use (RHP) and low use (RLP) of pesticides, and farmers cultivating rice and fish with a high use (RFHP) and low use (RFLP) of pesticides. 80% of the HP farmers relied mainly on pesticides to control pests, while >80% of the LP farmers also applied IPM strategies. Insecticides were the most commonly used pesticides. 85% of all farmers experienced health effects from using pesticides. 80% of the farmers felt that the yield of fish had decreased over the last three years, and that this mainly was caused by pesticides. The RFHP farmers had lower fish survival and fish yields as compared to the RFLP farmers. The RFHP farmers also had significant lower rice yields than the RFLP farmers, and there were significant correlations between both decreased fish yields and rice yields with increased use of pesticides among rice-fish farmers. Increased rice yields were positively correlated with increased fish survival, indicating the synergistic effects between rice and fish production. Overall, the RFLP farmers had the highest income of the four farmers´ groups, while RFHP farmers had the lowest income. This shows that rice-fish farming provides a competitive and sustainable alternative to intensive rice-farming, but only if the farmer restricts the use of pesticides. This would not only help to reduce the production costs, but also to decrease environmental and health effects, and it is proposed that rice-fish farming with a low use of pesticides provides an attractive alternative to rice-monocropping for a sustainable and diversified food production in the Mekong Delta.