A test of three hypotheses of pica and amylophagy among pregnant women in Tamil Nadu, India.

OBJECTIVES Pica has been studied in India and elsewhere for more than 100 years, yet no compelling and empirically well-supported explanation for it has emerged. Amylophagy, sometimes considered a type of pica and sometimes studied separately, is less frequently investigated and also lacks a convincing explanation. This study used a biocultural approach to test three hypotheses of pica and amylophagy: protection, hunger/nutrition, and psychological distress. METHODS The research took place in Tamil Nadu, India. In study 1, a cultural investigation was carried out among nonpregnant, adult women (n = 54) to determine nonfood substances that are consumed in this region and perceptions of health consequences. Next, using the substances identified in Study 1, three hypotheses of pica and amylophagy were tested in a cross-sectional study of pregnant women (Study 2, n = 95). Logistic regression analysis was used to analyze the presence or absence of engaging in pica and amylophagy. A series of bivariate analyses were used to examine the variation in amount and frequency of consumption. RESULTS Study 1 revealed that cultural attitudes strongly shape the selection of nonfood substances. In Study 2, the presence or absence of pica was not predicted by any of the variables included in the study, whereas the frequency and amount of consumption of pica substances were primarily explained by the psychological distress and hunger/nutrition hypotheses. Both the presence or absence of amylophagy as well as the frequency and amount of consumption were best explained by the protection hypothesis. CONCLUSIONS This research provided partial support for the protection and hunger/nutrition hypotheses for amylophagy, and also provided some evidence for the role of psychological distress and hunger or nutrition in pica.