Marketing violations involving products that compete with breastfeeding in the vicinity of early childhood education centers and health centers: a cross-sectional study based on an audit of the retail food environment, Maceió, 2022–2023

Abstract Objective Evaluate violations of the Brazilian Code of Marketing of Infant and Toddler Food, Teats, Pacifiers, and Baby Bottles (NBCAL) in the retail food environment around health centers and early childhood education centers in Maceió. Methods This cross-sectional study, conducted between April 2022 and March 2023, audited all food retail outlets selling products regulated by the Code in the vicinity of health centers and early childhood education centers. The results were expressed as frequencies. Results Of the 1,176 food retail outlets audited, 8.8% showed violations. The violations were concentrated in pharmacies (65.0%) and supermarkets (26.2%). When examining these two types of establishments (n=601), it was observed that 41.6% of those affiliated with retail chains exhibited violations. The probability of violation in retail chains was 6.8 times higher (95% confidence interval: 4.5-10.2) than in independent establishments. The most frequent violations occurred in follow-up formulas for early childhood children (27.5%), infant and follow-up formulas for infants (22.0%), and dairy compound products (19.7%). The promotional strategy most associated with the violations was special display (74.7%). Conclusion The retail food environment in Maceió revealed violations of the Code, with pharmacy chains and supermarkets posing the main threats to breastfeeding. Given the responsibilities of distributors and industry provided for in the legislation, this work reported abusive marketing practices that negatively impact the human right to adequate food and nutrition of children.