August 30, 2019

Cardin, Van Hollen and Colleagues Demand Answers from HHS on Sudden End to Women’s Health Helpline

WASHINGTON – U.S. Senators Ben Cardin, Chris Van Hollen (Both D-Md.) and colleagues are seeking answers from the Department of Health and Human Services (HHS) on the abrupt shutdown of the Women’s Health toll-free hotline, which has helped tens of thousands of women with accurate and reliable medical information for more than 20 years. Writing to Secretary Alex Azar and the Director of the HHS Office on Women’s Health (OWH) in response to constituent complaints, Senators Cardin and Van Hollen, along with Senators Ron Wyden (D-Ore.), Amy Klobuchar (D-Minn.), Bob Casey Jr. (D-Pa.), Tammy Duckworth (D-Ill.) and Maggie Hassan (D-N.H.) “are seeking answers about OWH’s decision to shutter the helpline and the agency’s plan for ensuring that all women, including the most vulnerable populations, have access to accurate and reliable medical information and resources.”

There was no announcement or public warning that this helpline would be stopped. The telephone number for this helpline continues to be displayed prominently on the OWH website and it is listed as a resource for other women’s health programs including women veterans. Constituents have reached out with complaints that the helpline no longer answers questions. In fact, dialing the toll-free phone number (1-800-994-9662) works through an automated system that eventually tells callers to call back during business hours, even when it is regular business hours. Employees at the helpline call center, which is located in Silver Spring, Md., reportedly have been laid off. 

HHS has indicated that they are not legally mandated to maintain the helpline since they provide many public health resources online.  However, according to PEW Charitable Trusts, nearly 1 in 10 Americans do not use or have access to the Internet. This proportion increases to nearly 1 in 4 rural Americans who do not have access to online resources. The OWH telephone line provides a resource that is far more accessible for many Americans than online information. 

The full letter is below and at this link.

  

The Honorable Alex Azar

Secretary

U.S. Department of Health and Human Services

200 Independence Avenue S.W.

Washington, D.C. 20201

 

Dorothy Fink, M.D.

Deputy Assistant Secretary for Women’s Health and Director

Office on Women’s Health

U.S. Department of Health and Human Services

200 Independence Avenue S.W.

Washington, D.C. 20201

 

Dear Secretary Azar and Assistant Secretary Fink:

We write to inquire about the operation of the Department of Health and Human Services (HHS) Office of Women’s Health (OWH) toll-free helpline (1-800-994-9662) and express concern about the fact that the helpline is no longer responding to calls and appears to be out of service. We were informed of this change by constituents and are seeking answers about OWH’s decision to shutter the helpline and the agency’s plan for ensuring that all women, including the most vulnerable populations, have access to accurate and reliable medical information and resources.  

As you know, the OWH helpline has been in place since 1998 and has facilitated tens of thousands of calls each year from women seeking information on pregnancy, breastfeeding, domestic violence, sexual assault, mental health, and other medical conditions or issues.[1] Among other things, current law requires that the National Women’s Health Information Center (NWHIC) “facilitate the exchange of information regarding matters relating to health information, health promotion, preventive health services, research advances, and education in the appropriate use of health care” and “facilitate access to such information.” While current law does not specify that OWH must maintain a toll-free helpline as part of the NWHIC, we believe that the toll-free helpline is essential in carrying out the well-defined mission of the NWHIC.[2]

In 2014, over 21,000 people called the OWH helpline looking for information or resources.[3]  OWH has historically touted the importance of this toll-free helpline and recognized the importance of having alternative forms of outreach. According to OWH’s website, “a key part of the National Women’s Health Information Center (NWHIC) was the toll-free call center—an alternative way to reach people who needed women’s health information.”[4]  In addition, yearly reports from OWH have included quotes from individuals who used the helpline and found it extremely helpful in answering their health questions.  In 2011, one woman wrote “Your services have been invaluable for me.  I have called [the OWH helpline] several times over my year of nursing and have always been helped by quality, knowledgeable, and friendly staff.  You have been so supportive and I am very grateful… I think more hospitals should share this and utilize this as a resource for all new mothers.”[5] 

Similarly, Congress has recognized the importance of the human connection when discussing personal health care challenges and the fact that many people would prefer to have a conversation and share their specific experiences or concerns. When OWH established the helpline, the Senate Appropriations Committee recognized its importance stating, “Currently, women facing health problems, their families, women’s health organizations, and health care providers must walk through a maze of HHS agencies to find appropriate information on women’s health. [Now] women across the country will be able to speak to women’s health information specialists about their health concerns and be directed to resources available in their communities.”[6] We continue to believe that the telephone helpline provides a service that cannot be entirely replaced by online resources alone.

We are particularly concerned that the elimination of the toll-free helpline will adversely impact women in underserved communities, which is clearly counter to the goals set out by Congress and the mission of the OWH.  While most people do have access to public information via online resources, nearly one in ten Americans does not use the Internet.[7]  HHS has indicated to us that having public health information available on agency websites and social media accounts fulfills their necessary legal mandates.  However, by limiting access to information through the Internet only, OWH is restricting access to vital health information for large segments of the population. For example, one in eight black and Hispanic individuals, one in four senior citizens, and one in eight individuals in rural communities lack Internet access.[8] By comparison, relatively few Americans do not have access to a telephone (approximately 3 percent).[9]  We appreciate that OWH has kept up with changing consumer culture by developing online resources, but this does not mitigate the continued need to provide accessible information to all Americans, including those without broadband access.

We ask that you submit answers to the following questions by September 30th, 2019.

  1. Please share any data that OWH has on the characteristics of individuals who used the helpline.
  2. What is OWH’s outreach plan to these individuals to ensure that they have access to the information they need in light of the hotline no longer being in service?
    1. What is OWH’s strategy to increase outreach to rural and underserved communities that may lack reliable Internet access?
    2. The FY 2020 HHS budget justification indicates that OWH plans to retire a large amount of communication resources, including social media channels.  Please describe what public health resources will remain, and how will OWH ensure that it continues to meet the health education needs of all women? 
  3. We understand that HHS/OWH uses a federal contractor(s) for its website and helpline services.
    1. Why did HHS/OWH cancel or not renew its contract for the toll-free helpline?
    2. Did HHS/OWH request any modifications to the helpline’s contract? If so, what were those modifications?
    3. Did HHS/OWH request any modifications to the website? If so, what were those modifications? Have those modifications been made yet?
    4. Does HHS/OWH use the same federal contractor for its website and helpline? What is the name(s) of the federal contractor(s)?
    5. What state is the helpline’s federal contractor located in?
    6. How many individuals were employed under the helpline’s contract; and what state were those individuals located in?
  4. Does HHS/OWH have any plans to restart the toll-free helpline with a federal contractor or with agency staff? If so, when?
  5. What was the cost of maintaining and operating the OWH helpline? How was the OWH helpline funded each year? 
  6. How many calls did the OWH helpline receive in 2018?
  7. Are there any other government-funded national toll-free helplines that provide similar information and services? If so, please provide specific information on what is covered by other helplines. 

Thank you in advance for your attention to this request. We look forward to hearing from you.

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[1] HHS Activities to Improve Women’s Health As Required by the Affordable Care Act. U.S. Department of Health and Human Services. Office of the Secretary.  Office on Women’s Health.  2015.  

[2] 42 U.S.C. § 237a(b)(5).

[3] HHS Activities to Improve Women’s Health As Required by the Affordable Care Act. U.S. Department of Health and Human Services. Office of the Secretary.  Office on Women’s Health.  2015.  

[4] 42 U.S.C. § 237a(b)(5). 

[5] Sebelius, K.  Secretary of Health and Human Services.  Report of Activities Related to “Improving Women’s Health As Required by the Affordable Care Act”.  March 23, 2011.

[7] Anderson, M., Perrin, A., Jiang, J., & Kumar, M. (10% of Americans don't use the internet. Who are they?  PEW Research Center. April 22, 2019.

[8]Ibid.

[9] Blumberg, S., Luke, J.  Wireless Substitution: Early Release of Estimates from the National Health Interview Survey, January-June 2018.  Division of Health Interview Statistics, National Center for Health Statistics.  December, 2018.