In this article we take a comparative look at strategic opportunities and barriers for action on nutrition in Pakistan’s four provinces in the post-devolution context. Provinces have faced historically common constraints of lack of a comprehensive policy and minimal allocations by the state, driven by low visibility of nutrition, siloed working of sectors and weak coalitions. Provinces also face common contextual impediments of poverty, patriarchy, and inadequate health and WASH coverage, with two provinces also constrained by inequitable power structures. Recent focusing events have provided a window of opportunity to the provinces for action on nutrition leading to definite movement towards horizontal coordination for nutrition, upscaled funding and stronger vertical integration. However, there are variations in the extent of coalition building on nutrition, supportive leadership, governance and community outreach. The Pakistan experience shows that strategising for nutrition needs to move beyond a closely tailored national policy to accounting for sub-national potential and constraints.