The move towards reducing environmental and health risks related to pesticide application in smallholder agriculture requires a more detailed understanding of farmers’ awareness and pesticide use practices. Drawing on field observations and interviews with 90 randomly selected farmers, this study assesses the choice of pesticide, use patterns and the level of awareness of pesticide risks among male and female farmers growing vegetables on Idjwi Island, eastern Democratic Republic of Congo. The main crops grown are tomatoes, eggplants, and cabbages, which are vulnerable to pest attacks, leading to fruit rot (70%), leaf holes, and spots (17%), resulting in significant economic losses. To protect crops, farmers use various pesticides, including fungicides (e.g., Metalaxyl, Mancozeb) and insecticides (e.g., profenofos, Cypermethrin), based on their availability on local market, perceived effectiveness, and relatively affordable prices. Although the results did not reveal significant differences in pesticide use patterns between male and female farmers, men (41%) make decisions about pesticide purchase and use within households either alone or jointly with their spouses (31%). Regrettably, farmers disregard safety instructions and hygiene practices following pesticide application, leading to concerns about public health and the environmental impact of using these products. While we highlight the factors influencing farmers’ willingness to wear protective equipment, findings also show that 75% of the participants are willing to pay $US 5 for any alternative method to pesticide use. This study emphasizes the need for improving awareness and recommends field farmers’ schools to train farmers on pesticides’ proper usage and management. The results suggest further research on farmers’ exposure to pesticide and the exploration of existing alternative methods based on integrated pest management to advance sustainable agriculture.