Brazil is a continent-size country with around 190 million inhabitants, the largest and most populous in South America. It is classified as a developing upper middle-income country and having considerable growth, although inequality remains significant. The health system is mixed; most of the population is served by the public Unified Health System ("Sistema Único de Saúde", SUS) and there is a thriving private health sector. The country faces multiple obstacles to improve and expand genetic services, due to its wide territory, sociocultural inequalities and major basic health problems. Most comprehensive genetic services are concentrated in large urban centers in the South and Southeast regions, mainly in tertiary care university hospitals. Demand for genetic services has increased and congenital malformations has been the second cause of infant mortality since 2000, but such data did not determine government policies or initiatives for the prevention and management of this group of problems until 2004, when the process for introducing medical genetics as a health policy by the Ministry of Health began. Details on the policy and an overview on congenital and genetic diseases, the state and availability of genetic services, genetic testing, medical genetics laboratories, training of human resources in medical genetics, newborn screening program, genetics networks, special care facilities, as well as educational, social and support programs for disabled people, research priorities in genetics and genomics, patient organizations and relevant issues regarding the challenge of implementing a comprehensive care policy in clinical genetics in this vast and diverse country are presented.