Breastmilk Substitutes Marketing Violations and Associated Factors in Rio de Janeiro, Brazil

Abstract

Background Aiming to protect breastfeeding, the World Health Organization released the International Code of Marketing of Breastmilk Substitutes in 1981, which was adopted by the vast majority of the 118 member countries, including Brazil. The Brazilian Code regulates the marketing of infant formulas, baby bottles, teats, pacifiers, milk, and processed complementary food. Research aims (1) To determine if retail stores had violated the Brazilian Code and (2) to analyze factors associated with these violations. Methods This cross-sectional study included all drugstores, supermarkets, and department stores in the Southern Zone of Rio de Janeiro City, Brazil. Trained health professionals observed retail stores for marketed products and violations of the Brazilian Code and then interviewed their managers. Factors associated with the retail stores violating the Brazilian Code (outcome) were analyzed, employing a logistic regression model with 95% Confidence Interval. Results Of the retail stores ( N = 349) evaluated, 62.8% violated the Brazilian Code, ranging from 1 to 37 violations per retail store. The most common promotion strategies were price discounts and special displays. Retail stores being part of a chain store (aOR = 4.59) and their manager receiving visits from industry business representatives (aOR = 2.14) were associated with the presence of violations. Conclusions The prevalence of Brazilian Code violations was high, especially in chain stores. The association between regular visits by industry representatives and violations suggests an indirect influence of manufacturers on the promotion of human milk substitutes. We recommend strengthening compliance with the Brazilian Code through calling on governmental surveillance agencies and civil society mobilization.

Global evidence of persistent violations of the International Code of Marketing of Breast‐milk Substitutes: A systematic scoping review

“…Retail is a major setting for BMS promotion and there is no mention in the Code of restrictions on marketing activities by companies to retail staff. Studies reported BMS companies training retail staff, including staff in pharmacies, on how to market their products and offering these staff sales incentives (Baby Milk Action UK, 2017; Oliveira et al, 2021).…”

Violations in the marketing of milks and complementary foods that compete with breastfeeding in Rio de Janeiro City, Brazil

“…However, another study from the research "Evaluation of the compliance with the Brazilian Code of Marketing of Infant and Toddler's Food in Commercial Establishments", through a logistic regression model, analyzed the factors associated with non-compliance with the NBCAL in the South Region of the city of Rio de Janeiro and reported no association between non-compliance with the law and the location of commercial establishments. 15 Finally, it is worth mentioning that the present study evaluated compliance with the NBCAL in the commercialization of milk and complementary foods in the South Region of Rio de Janeiro, and the extrapolation of these results to other regions of the city or to other municipalities is limited.…”

“…This is an epidemiological survey, part of the research "Evaluation of the compliance with the Brazilian Code of Marketing of Infant and Toddlers Food in Commercial Establishments", which included a census of commercial facilities (pharmacies, supermarkets and department stores) in the South Region of the city of Rio de Janeiro, which was selected for holding a population from various social segments (low, medium and high income) distributed across 18 neighborhoods 14 of the upper class, such as Leblon and Ipanema, and low-income, such as the communities of Rocinha and Vidigal, which are characterized by irregular soil and poor urban infrastructure. 15 In this study, an initial list of commercial facilities was created by consulting the Tele-Listas, and with address information obtained from the websites of the main commercial networks. For data collection, all supermarkets, pharmacies and department stores located in the selected region were visited; those that were not included in the previous list and were found by the interviewers when commuting through neighborhoods were also added to the study.…”

Irregular practices in drugstores in the offer of products for children under three years old

“…Our results are in line with those of the monitoring carried out by IBFAN 8 in previous years and a study conducted in the south of Rio de Janeiro. 9 , 10 In studies carried out in Cambodia, Nepal, Senegal, and Tanzania there was also a presence of sales advertisements, and it was less prevalent in countries where the legislation protecting breastfeeding is stronger. 17 In Zambia, the rate of non-compliance with the code by the manufacturers and distributors of breast-milk substitutes was 8 and 14% respectively; and the main strategy used was special exhibition.…”

“… 9 Another study that considered all products, including toddler formula; complementary and cereal-based foods; liquid/powdered, modified, or plant-based milk found that 62.8% of establishments violated NBCAL. 10 In both studies, 9 , 10 the most frequent commercial promotion strategies were discounts and special exposures.…”