Table 4.

Themes and subthemes emerging from in-depth interviews to assess breast-feeding related actions, 2017 earthquakes in Mexico

Themes	Subthemes	Findings
1. Lack of knowledge about the importance of protecting and supporting breast-feeding during emergencies	1.A. Not knowing why breast-feeding is a relevant topic during emergencies	–Issue among governmental and civil society actors. –Not understanding the relationship between emergencies and breast-feeding.
	1.B. Lack of knowledge leading to distribution of formula	–At gathering and distribution centres, there was no knowledge of how to distribute formula; it was distributed to affected families through pantries as a “basic product”.
2. Unclear institutional protocols to protect and support breast-feeding during emergencies among governmental officials	2.A. Lack of clarity regarding who is in charge of managing formula during emergencies	–During the interviews with informants, it became evident that there was a lack of information about who should have been in charge of formula. –Ministry of Health did not internalise its leadership.
	2.B. Protocols such as having a safe place to breastfeed in shelters were not always followed	–Key informants who visited shelters could not confirm that safe places to breastfeed had been established.
3. Lack of enforcement of the Code and the OG-IFE	3.A. Donations and distribution of formula were not supervised	–COFEPRIS should have supervised donations and supervised formulas at gathering centres and shelters, but they did not. They only supervised drug donations. –Led to massive donation and distribution of formulas with disregard for the recommendations of the Code and the OG-IFE. –Donations of formulas with close expiration dates.
4. Actions and reactions of citizens	4.A. Reactions to actions to protect and support breast-feeding	–Negative reactions of citizens when breast-feeding experts tried to send messages to encourage breast-feeding women.

OG-IFE, Operational Guidance on Infant and Young Child Feeding in Emergencies.