The Influence of Human-Milk Substitutes Marketing on Breastfeeding Intention and Practice among Native and Immigrant Brazilians.

Background: The International Code of Marketing of Breast-Milk Substitutes is a global public health policy aiming to protect breastfeeding from the influence of human-milk substitutes marketing. Brazil is one of the few countries substantially implementing it. Most countries adopted selected provisions, including Portugal.

Research Aim: To explore whether Brazilians' perspectives about breastfeeding intention and practice are influenced by human-milk substitutes marketing upon migration to Portugal.

Methods: A qualitative, prospective, cross-sectional survey design was conducted in Brazil and Portugal (2018-2019). Qualitative semi-structured interviews were performed with native ( = 16) and immigrant ( = 15) Brazilians. Women aged 18 or above, mothers of 0-12 month infants, and without contraindications to breastfeed, were eligible for the study. Heterogeneity sampling was employed based on socioeconomic status and infants' age. Content analysis was conducted using NVivo.

Results: Brazilian immigrants were more aware of the potential negative influence of human-milk substitutes marketing than natives. Sociocultural factors contributed to Brazilian immigrants being less permeable to the influence of human-milk substitutes marketing in the host country, where a less protective breastfeeding environment was perceived.

Conclusions: Sociocultural factors including breastfeeding promotion strategies and a strong breastfeeding culture in the home country appear to play a protective role on breastfeeding intention and practice among Brazilians migrating to Portugal.