Abortion is a lot more common in India than government data suggests.

A study published this week (pdf) in The Lancet Global Health journal estimates that 15.6 million abortions occurred in the country in 2015, significantly higher than the 701,415 recorded by the ministry of health and family welfare for 2014-2015. Moreover, a staggering 78% (12.3 million) of these abortions were undertaken outside of health facilities, suggesting that Indian women are taking the procedure into their own hands.

The study was conducted by a team of authors from the Guttmacher Institute in New York, the International Institute for Population Sciences, Mumbai, and the Population Council, New York.

To estimate the national abortion incidence, they used data mostly from the 2015 Health Facilities Survey of six Indian states—Assam, Bihar, Gujarat, Madhya Pradesh, Tamil Nadu, and Uttar Pradesh—NGO clinics, and abortion pill sales and distribution.

The authors say that India’s national surveys and official statistics have so far offered an incomplete picture as they don’t take into account abortions by private-sector doctors who don’t work at registered facilities or abortion services provided by professionals of alternative medicine, notably Ayurveda, Unani, and Homeopathy. The government data also excludes untrained providers of abortions and abortion pills that don’t require prescriptions. These pills have become increasingly available in pharmacies from the early 2000s.

“Most abortions are happening without prescriptions and outside of facilities via chemists and informal vendors, which suggests the need to improve facility-based services,” the authors write. While abortion pills can be effective and safe when administered correctly, they say it is unclear if Indian women are getting the right information and using them properly.

In conservative India, where talking about sex remains a taboo, previous studies have shown that the use of contraceptives has been declining. More people are turning to morning-after pills and abortions despite the potential health risks. While the study was unable to determine the reasons for the high rate of abortions in India, they accounted for one-third of the pregnancies in 2015. And almost half of the pregnancies that year were unintended, the authors say.

It’s clear then that educating the public about contraceptives and abortions go hand-in-hand. The study says the government will have to adapt to the reality, making safe abortion services available across the country. It will also need to ensure that women from all segments of society have access to the right information.

“Many of these recommendations are particularly needed at primary health centres because these facilities are the most accessible to the majority of women who live in rural areas and who are least likely to be able to afford private services,” the authors write. They add that policy-makers should take into the account the fact that some women may only have access to medication abortions, making it all the more important to provide accurate information on the use of abortion pills, and access to health care if any complications come up.