Agricultural production and household food security are hypothesized to play a critical role connecting climate change to downstream effects on women’s health, especially in communities dependent on rainfed agriculture. Seasonal variability in agriculture strains food and income resources and makes it a challenging time for households to manage a pregnancy or afford a new child. Yet, there are few direct assessments of the role locally varying agricultural quality plays on women’s health, especially reproductive health. In this paper we build on and integrate ideas from past studies focused on climate change and growing season quality in low-income countries with those on reproductive health to examine how variation in local seasonal agricultural quality relates to childbearing goals and family planning use in three countries in sub-Saharan Africa: Burkina Faso, Kenya, and Uganda. We use rich, spatially referenced data from the PMA individual surveys with detailed information on childbearing preferences and family planning decisions.