This chapter analyses the governance structures linked to the marine environment of the Baltic Sea. The purpose is to assess whether current developments of the governance structures have a potential to take into account requirements of an Ecosystem Approach to Management (EAM). We use the concept of reflexive governance to understand key components and weaknesses in contemporary governance modes, as well as to elaborate on possible pathways towards a governance mode more aligned with EAM. The reflexive governance framework highlights three elements: (1) acknowledgement of uncertainty and ambiguity; (2) a holistic approach in terms of scales, sectors and actors; and (3) acknowledgement of path dependency and incremental policy-making. Our analysis is based on a comparative case study approach, including analysis of the governance in five environmental risk areas: chemical pollution, overfishing, eutrophication, invasive alien species and pollution from shipping. The chapter highlights an existing governance mode that is ill-equipped to deal with the complexity of environmental problems in a holistic manner, with systematic attention to uncertainty, plurality of values, ambiguity and limited knowledge, while also pointing at important recent cognitive and institutional developments that can favour pathways towards reflexive governance and consequently EAM.