In many cities of developing countries untreated wastewater and polluted water are used for agriculture in urban and peri-urban areas. Though such practices are a threat to the health of users and consumers, they do provide important livelihoods benefits and perishable food to cities. This paper through a cross country analysis of 53 cities in the developing world, provides an understanding of the factors that drive wastewater use. The 53 cities represent a range of settings in arid and wet areas, in rich and poor countries, and coastal as well as inland cities to provide a picture of wastewater use globally. It relates the wastewater collection and disposal practices to the increasing impact of poor water quality on agriculture.