National System to Monitor the International Code of Breast Milk Substitutes in Brazil: SisNBCAL

Abstract

Abstract Objectives We aim to describe the research protocols developed for the System to Monitor the International Code for Breast Milk Substitutes NBCAL in Brazil (known as “The Brazilian Code”). Methods We have developed an internet-based program for ongoing monitoring of the Brazilian Code. Eleven institutions from all the 5 Brazilian regions were involved to develop and validate a standardized questionnaire to monitor retail stores and health facilities. This questionnaire was adapted to the system and can be filled in a computer or mobile device. Three users were designed: citizens, governmental agencies, research institutions, with different accesses and data entry. Results Besides the creation of a questionnaire, we have developed standardized indicators to enable in-country comparations regarding the type of Brazilian Code violations, namely: 1. frequency of marketing by product groups and by type of commercial establishment; 2. prevalence of infringement by product group and by type of commercial establishment; 3. prevalence of each commercial promotion strategy by type of establishment; 4. prevalence of infractions of infant formulas and childcare-related products by company. Violation of the Brazilian Code was categorized in the price discounts or offers, special exposure on gondola tips or in highlighted displays and the distribution of promotional gifts or free samples of these items are prohibited. We have found violations of the Brazilian Code in 60,1% of the 1487 retail stores evaluated and 24,2% of the 14 hospitals accessed. Conclusions Understand and evaluate the main marketing strategies and violations of the Brazilian Code” trough the Sis-NBCAL is essential to progress in strengthening compliance with the “Code” and subsequent protection of the breastfeeding, guaranteeing a marketing-free environment to enable mothers and their families to make the best food choices for their children. Funding Sources Oswaldo Cruz Foundation/Ministry of Health: “Idéias Inovadoras” grant.