In the Baluchistan Province of Pakistan, under-nutrition remains a recognized health problem and plays a substantial role in the region’s elevated maternal and child morbidity and mortality rates. Fifty-two per cent of children have stunted growth, 73.5% of children and 60.7% of pregnant women have vitamin A deficiency. In this report a nutrition governance framework was applied to research and analyse the provincial experience with nutrition policy in Pakistan, looking both at chronic and acute malnutrition. Fourteen in-depth interviews and two focus group discussions with key stakeholders were also conducted along with a review of published and grey literature. Findings were validated and supplemented by consultative provincial roundtable meetings. The province faces stiff contextual challenges, including a lack of drinking water, poor sanitation, low food production, difficult community outreach (which makes it harder to implement services and to reach beneficiaries), and patriarchal systems and beliefs. Although schemes such as cash transfers to the poor, school feeding, and food distribution for people affected by disaster are in place, there are few connections between relevant sectors. Services also do not always reach those who are most at risk of under-nutrition, particularly low-income pregnant women and children under three years of age. Strategic opportunities are recommended which include increased technical support to capitalize on existing momentum; development of a common support base across party lines without political capture; integration of nutrition within the operational budgets of key sectors to have a better chance of maintaining continuity; stronger vertical accountability; greater attention to underlying factors affecting nutrition e.g. water access; addressing food security to be more resilient to food price shocks; expansion and better implementation of preventive and promotional nutrition strategies within existing health programmes and a greater role for INGOs and national NGOs in partnerships around data production, awareness, advocacy and monitoring.