Reading Time: 7 minutes Photo of a sex workers rights march in Canada. Posted on Flickr by Sally T. Buck. Creative Commons license.
Reading Time: 7 minutes

The anti-sex-worker bias seen in the American Plan dovetails with forced sterilization and medical experimentation, as well as straight-up misogyny. It was enforced until the 1960s and 70s, if you can believe it. Here’s a rundown of the American Plan’s impact.

Photo of a sex workers rights march in Canada. Posted on Flickr by Sally T. Buck. Creative Commons license.

Based in an attempt to regulate prostitution in order to control the spread of STIs, and fueled by World War I, the American Plan allowed law enforcement and medical experts to legally detain women indefinitely from 1917 onward. They were put into prisons and dormitories, hospitals and farms, and kept without warrants and treated for diseases they might not even carry, all while the men who paid them for sex went free (if the women were even sex workers in the first place; many were not).

The hypocrisy and misogyny of the American Plan is clear in one particularly action-packed case from the Roaring Twenties. In 1922, a woman named Marie Hamilton was jailed for stealing a car with some male friends and going on a joy ride from Nashville to Detroit. Hamilton pleaded guilty and received the heaviest sentence, because it was believed that she was not only leading these young men astray, but also that she was scattering syphilis wherever she went. The judged wanted her in prison both to address her supposed STI status, and so that she might learn “to lead a good, upright, clean, and honest life” (quoted in Stern, 185). However, Hamilton wrote letter after letter in order to get her sentence reduced, which eventually worked.

Technically, Hamilton was not imprisoned under the American Plan. However, once the American Plan became law, it meshed seamlessly with the existing justice system precisely because both operated under the same stereotypes and beliefs about gender and sexuality; the Plan “reinforced long-standing negative attitudes toward sexually active women and served to concretize discriminatory and paternalistic practices” (Stern 186). Many of these attitudes, as Stern describes them, are still in evidence today, upholding rape culture, in the beliefs:

that young women were responsible for the indiscretions of young men; that promiscuity in women was worse than it was in men; that STIs merited jail time for women; that women could not merely serve their time as men did, but that they had to be cured of disease and be “reformed” in order to merit release (186).

The vulnerability of American women to the Plan cannot be overstated, especially for women already impacted by intersectional oppression (such as poor women, immigrants, and women of color). Stern supplies a list of examples of the outrageous ways in which women were detained under the Plan:

One woman, for instance, was arrested and examined for defending a friend from the police; another woman was detained for no apparent reason mere hours before her wedding. One woman owed rent to a former sheriff, who had her taken in on suspicion when she could not afford to pay; another was arrested after changing jobs, when her former boss vengefully reported her to the health officer. One woman was arrested after her car broke down; another was examined after volunteering to be a witness against men accused of stealing a car. The presence of alcohol often led to women’s interments: one was arrested for pouring an acquaintance’s alcohol out the window of a car, while another was prescribed whiskey by her doctor to treat tuberculosis; when the police found the liquor on her they brought her in. One woman was forcibly examined after just being on a date with a man who was drinking (78).

This is what legalized social control of a population looks like. And it went on for decades.

Funding for the American Plan receded after WWI ended, but the Plan remained on the books. Then a surgeon general named Thomas Parran helped revitalize the Plan just in time for it to gain increased momentum. Parran and other ASHA (American Social Hygiene Association) officials kept pushing the government to commit funds to fighting STIs, and started gaining ground in the late 1930s. Parran advanced his career by enforcing the American Plan at various levels, and thus by the time America entered World War II, the stage was set to once again position STIs as a threat to national security. ASHA also began to implement nation-wide sex education, again spurred on by the view that public health impacted the war-time effort.

When Parran became surgeon general in 1935, he also inherited the Tuskegee study, a decades-long breach of medical ethics wherein the U.S. government allowed African-American men with syphilis to go untreated in order to observe the effects of the disease (see the CDC page about it here). What is notable is that the study’s creators had also been active in enforcing the American Plan during WWI. Scott Stern summarizes the chilling connections between the Tuskegee study and the American Plan:

The Plan reinforced for these physicians their authority and power over those whom they viewed as subordinate and inferior, especially women, especially (and disproportionately) women of color. The Plan reinforced for these physicians the unimportance of consent when it clashed with their ideas of what was best. […] Tellingly, these physicians decided not to examined black women because they were seen as too promiscuous; black men, on the other hand, were seen as perfect test subjects: too poor and ignorant to complain; too insignificant to merit treatment (203).

Further, eugenics (selective breeding/sterilization practices) are implicated along with the American Plan. As Stern argues, records were not kept (or kept well) on this issue, so we don’t know how many American women were sterilized under the American Plan. But consider this case of a 14-year-old whose mother had prostituted her:

This girl was treated for her STI, then transferred to the industrial school at Beloit [Kansas] (despite having been convicted of no other crime). Soon, though, she was shipped back to the farm, where (though her IQ was well above the “feebleminded” range) she was sterilized. Her even younger sister – convicted not under the Plan but, instead, of having “immoral associates” – was likewise “desexed” (198-199).

After WWII, the American Plan began to fall apart. The exposure of the deep and long-lasting harm carried out by the Tuskegee study came to light in 1972, shaking public faith in ASHA, and medical ethics in general. And formerly marginalized women, the victims of the American Plan for decades, began to be able to voice their concerns using platforms formerly denied them. For example, in 1965, Andrea Dworkin (a second-wave feminist) was arrested at an antiwar protest and forcibly examined for STIs under American Plan laws. The examination left her bleeding for days and re-traumatized (as she had already been a victim of sexual assault). Dworkin managed to get her story covered by major newspapers, and this led to scandal and resignations. Stern writes: “The sustained media attention focused on the treatment of female prisoners, and especially their STI examinations, coupled with the coincidental passage of a new state law reducing penalties for prostitution, finally conquered the surviving remnants New York’s American Plan” where Dworkin had been (252).

However, because the American Plan was always enforced at multiple levels, it clung in some parts of the country. San Francisco kept it on the books until 1974, when Margo St. James (a sex worker advocate and founder of COYOTE, Call Off Your Old Tired Ethics) helped put a lawsuit into motion. The ACLU hopped on board, getting Oakland police departments to enforce the law on a gender-equal basis, and once the (male) customers visiting prostitutes also had to be quarantined by law for 5 days in jail, the practice dwindled.

The American Plan was not a secret, but it was largely forgotten after WWII. Much of Stern’s research was accomplished by digging in archives, and even then, he still had to assemble a lot of puzzle pieces. And the Plan haunts us still; it was invoked by HIV/AIDS activists resisting calls to quarantine them, and also by those trying to defend the quarantine. Stern writes: “When public health officials did quarantine a handful of individuals with HIV during the 1980s and 1990s – mostly prostitutes and others who were deemed ‘recalcitrant’ – courts frequently cited American Plan laws and precedents to uphold these actions” (261).

Is there ever a legitimate enough public health reason to quarantine individuals who have STIs? Maybe, maybe not, but for over half the time the American Plan was on the books, the STIs in question (syphilis, chlamydia, and gonorrhea) could be cured using penicillin. So there goes that defense, leaving the less-savory rationalizations of misogyny, racism, whorephobia, and more.

Despite spending 3 blog posts unpacking the American Plan, I’m afraid I’ve barely scraped the surface, so I encourage you to do some reading and research of your own. It’s worth noting that learning about it has completely changed the way I teach about the history of sex education in my college classes. So, I highly encourage you to read Stern’s book, though if you’re short on time, I’m also a fan of this New York Times book review of Stern’s book, The Trials of Nina McCall. The American Plan remains one of the nation’s largest medical ethics and human rights violations, and it eerily presages the contemporary ways in which state apparatuses oppress sex workers. We need to be informed about this history, so that we can fight this type of misogyny and oppression when it occurs today.

One more note: you’ll notice the red umbrella in the picture above, which symbolizes sex workers’ rights. While it appears that the website for the Red Umbrella Project (one advocacy group run by/for sex workers) has been suspended, I’m guessing due SESTA/FOSTA, you can find more information on sex worker activism at the Global Network of Sex Work Projects. Please support and uplift the voices and needs of sex workers, since they’re the ones on the ground being most impacted by all of these policies, past and present.



Scott Stern. The Trials of Nina McCall: Sex, Surveillance, and the Decades-Long Government Plan to Imprison “Promiscuous” Women. Boston: Beacon Press, 2018.

FOXY FOLKORIST Studied folklore under Alan Dundes at the University of California, Berkeley, and went on to earn her PhD in folklore from Indiana University. She researches gender and sexuality in fairy...

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