Successful management requires information on pressures that threaten a species and areas where conservation actions are needed. The Baltic Proper harbour porpoise population was first listed as Critically Endangered by the International Union for the Conservation of Nature in 2008. Now, 16 years later, there is no change in conservation status despite ample conservation policy calling for its protection and an urgent need for management action to protect this population. Here, we provide an overview of the current status of the population, highlight knowledge gaps on the impact of pressures, and make recommendations for management of anthropogenic activities. Based on an exceeded limit for anthropogenic mortality, the high concentrations of contaminants in the Baltic Sea, combined with reductions in prey availability and increases in underwater noise, it is inferred that this population is likely still decreasing in size and conservation action becomes more urgent. As bycatch and unprotected underwater explosions result in direct mortality, they must be reduced to zero. Inputs of contaminants, waste, and existing and emerging noise sources should be minimised and regulated. Additionally, ecosystem‐based sustainable management of fisheries is paramount in order to ensure prey availability, and maintain a healthy Baltic Sea. Stranding networks to routinely assess individuals for genetic population assignment and health need to be expanded, to identify rare samples from this population. Knowledge is still scarce on the population‐level impact of each threat, along with the cumulative impact of multiple pressures on the population. However, the current knowledge and management instruments are sufficient to apply effective protection for the population now. While bycatch is the main pressure impacting this population, urgent conservation action is needed across all anthropogenic activities. Extinction of the Baltic Proper harbour porpoise population is a choice: decision‐makers have the fate of this genetically and biologically distinct marine mammal population in their hands.