Monitoring the Brazilian Code: – the Violations Persist Marina F. Rea IBFAN National Committee of Breastfeeding, MoH Brazil WBC2, December 2016

NACIONAL CODE IN LATIN AMERICA AND CARIBIAN BRASIL 1988

BRAZILIAN CODE It is based in the International Code 1981 and subsequent relevant World Health Assembly Resolutions Approved in1988 – as a sanitary resolution Revised in1992 and in 2001. Approved as Law in 2006. Law regulated as a Decree 8552 in 2015.

The BRAZILIAN CODE was a process with wide participation of interested parties Including companies! Consequently, as a negotiated instrument, our Code has weak concepts, straight ones, as well as strong concepts. It is considered the country with the strongest regulation.

Brazilian is a stronger CODE. Why? - Wide scope: strong rules for labeling; strong definition of commercial promotion; restrictive rules for samples and donations - Wide objective: control of unethical marketing of infant formula, bottles, teats and pacifiers and foods for young children till 3 YEARS Partnership IBFAN with- Minister of Health and “Sanitary Survivor Agency of MoH (ANVISA)”. -LAW since 2006 - regularization (rules 2015, enact better definitions)

IBFAN Brazil Code Monitoring – 2015 Methods: data colection with a purposive sample in 19 cities of 10 states (provinces), done by IBFAN volunteers, covering all regions of the country. RESULTS: 227 irregularities or violations were observed in 52 companies. 19 companies agreed that they were not complying The irregularities or violations refer to commercial promotion in supermarkets, farmacies, retail outlets, health care units, internet and to inadequate labelling of products in the scope of the Brazilian Code (Law 11265/06).

IBFAN BRASIL MEMBERS ARE PRESENT IN ALMOST EVERY STATE OF THE COUNTRY.

TYPES OF VIOLATIONS Commercial promotion in retail outlets 104 Commercial promotion in internet (sites etc) 84 Magazines with promotion 18 Marketing for health professionals 9 Educational material in internet 6 Mislabelling of products covered by Code 5 Total* 227 * in the year 2015 we do not included interviews at health care units and with health professionals.

COMMERCIAL PROMOTION VIOLATING THE CODE Weaning food Infant formula bottle pacifier

VIOLATIONS IN MAGAZINE FOR PEDIATRICIANS

SAMPLING VIOLATIONS Only 11 companies responded to our notification 17 COMPANIES PRESENTED LABEL VIOLATIONS Only 11 companies responded to our notification and none agreed. Examples: UNILEVER (ADES): no warning DANONE (Fortini) -no warning DANONE (Pregomin) – wrong warning

EXAMPLE OF ADVANCES: change in labelling . The picture of an infant is not allowed; the brand “First Growing” referred to the infant growing and is a misconception. After our denounce, co.changed

EXAMPLE OF ADVANCES: change in labelling IBFAN Brasil denounce the violation: Our Code does not allow pictures of any type in infant formula. The company changes the label

DISCUSSION OF MAIN RESULTS: Our study had limitations: although Brazil has 26 states, we only included 10; the health care system, pediatricians and nutritionists were not included in our study, as these needs different methods. Although covering all regions of the country, the showed number of violations of the Code are still below what exist. Violation of Article 4 of the Brazilian Code, which prohibits any kind of commercial promotion of infant formula, nipples, pacifiers and bottles – was performed by 12 companies. This is serious! The commercial promotion of follow-up formulas without the warning required by law is increasingly present. The use of internet and social networking pages is a matter of concern, and it has had a constant presence of marketing of products covered by our Code, what is difficult to monitor. DISCUSSION OF MAIN RESULTS:

CONCLUSIONS Although launched in 1988, the Code violations in Brazil persist. Advances can be documented and celebrated. Legal protection of breastfeeding with the Code and National Codes should continue!!!