In the Khyber Pakhtunkhwa (KPK) 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. Forty-eight per cent of children have stunted growth 68.5% of children and 76.2% 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. Twenty 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. Despite KPK having less agriculture than other provinces and being dependent on them for food, it has lower levels of food insecurity than other provinces. Under-nutrition in KPK is linked to insufficient attention to preventive health strategies; lack of connections between relevant sectors, such as Education, Food, Health, Poverty, and Safe Water and Sanitation; and a lack of effective access to food by at-risk low-income pregnant women and children under the age of three. Strategic opportunities are recommended which include ensuring bipartisan support from the top to make and mainstream nutrition into development priorities; effective cross-sectoral coordination; stronger vertical accountability within sectors to enhance implementation; improved household food security and disaster resilience and long-term recovery; improved nutritional understanding, ownership and funding, stronger connection with nutritional targets and monitoring and evaluation of programmes and wider reach to the poorest and marginalised populations.