This article examines the role that gender inequality plays in limiting vertical HIV transmission (PMTCT) programmatic progress. The authors highlight a growing body of evidence that suggests that gender inequality, including gender-based violence, is a key obstacle to better outcomes related to all four components of a comprehensive PMTCT programme. Effective community- and facility-based strategies to transform harmful gender norms and mitigate the impacts of gender inequality on HIV-related outcomes are emerging. The paper calls for greater implementation of comprehensive, gender transformative PMTCT programmes in order to eliminate vertical transmission of HIV.