title: Martin of Tours

text: With the return of Hilary to his see in 361, Martin joined him and established a hermitage nearby, which soon attracted converts and followers. The crypt under the parish church (not the current Abbey Chapel) reveals traces of a Roman villa, probably part of the bath complex, which had been abandoned before Martin established himself there. This site was developed into the Benedictine Ligugé Abbey, the oldest monastery known in Europe. It became a centre for the evangelisation of the country districts. Martin travelled and preached through western Gaul: "The memory of these apostolic journeyings survives to our day in the numerous local legends of which Martin is the hero and which indicate roughly the routes that he followed."


title: Martin of Tours

text: In AD 371 Martin was acclaimed bishop of Tours, where he impressed the city with his demeanour. He had been drawn to Tours by a ruse — he was urged to come to minister to someone sick — and was brought to the church, where he reluctantly allowed himself to be consecrated bishop. According to one version, he was so unwilling to be made bishop that he hid in a barn full of geese, but their cackling at his intrusion gave him away to the crowd; that may account for complaints by a few that his appearance was too disheveled to be commensurate with a bishopric, but the critics were hugely outnumbered.


title: Martin of Tours

text: As bishop, Martin set to enthusiastically ordering the destruction of pagan temples, altars and sculptures:


title: Martin of Tours

text: Sulpicius affirms that Martin withdrew from the city to live in Marmoutier ("Majus Monasterium"), the monastery he founded, which faces Tours from the opposite shore of the river Loire. Recent excavations under the abbey church have revealed the traces of a Roman posting station, beside the main Roman road along the north bank of the Loire, which seems to have been the original dwelling for the community; the "caves" on the site are post-Roman and are probably the result of quarrying the coteau for the Romanesque abbey buildings.


title: Martin of Tours

text: "Here Martin and some of the monks who followed him built cells of wood; others lived in caves dug out of the rock." (Sulpicius Severus).


title: Martin of Tours

text: Martin introduced a rudimentary parish system. Once a year, the bishop visited each of his parishes, traveling on foot, or by donkey or boat. He continued to set up monastic communities, and extended the bounds of his episcopate from Touraine to such distant points as Chartres, Paris, Autun, and Vienne.


title: Martin of Tours

text: In one instance, the pagans agreed to fell their sacred pine tree, if Martin would stand directly in its path. He did so, and it miraculously missed him. Sulpicius, a classically educated aristocrat, related this anecdote with dramatic details, as a set piece. Sulpicius could not have failed to know the incident the Roman poet Horace recalls in several "Odes" of his own narrow escape from a falling tree.


title: Martin of Tours

text: Martin was so dedicated to the freeing of prisoners that when authorities, even emperors, heard he was coming, they refused to see him because they knew he would request mercy for someone and they would be unable to refuse.


title: Martin of Tours

text: The churches of other parts of Gaul and in Spain were being disturbed by the Priscillianists, an ascetic sect, named after its leader, Priscillian. The First Council of Saragossa had forbidden several of Priscillian's practices (albeit without mentioning Priscillian by name), but Priscillian was elected bishop of Avila shortly thereafter. Ithacius of Ossonoba appealed to the emperor Gratian, who issued a rescript against Priscillian and his followers. After failing to obtain the support of Ambrose of Milan and Pope Damasus I, Priscillian appealed to Magnus Maximus, who had usurped the throne from Gratian.


title: Martin of Tours

text: Although greatly opposed to the Priscillianists, Martin traveled to the Imperial court of Trier to remove them from the secular jurisdiction of the emperor. With Ambrose, Martin rejected Bishop Ithacius's principle of putting heretics to death—as well as the intrusion of the emperor into such matters. He prevailed upon the emperor to spare the life of the heretic Priscillian. At first, Maximus acceded to his entreaty, but, when Martin had departed, yielded to Ithacius and ordered Priscillian and his followers to be beheaded (in 385). Martin then pleaded for a cessation of the persecution of Priscillian's followers in Spain. Deeply grieved, Martin refused to communicate with Ithacius, until pressured by the Emperor.


title: Martin of Tours

text: Martin died in Candes-Saint-Martin, Gaul (central France) in 397. After he died, local citizens of the Poitou region and residents of Tours quarreled over where Martin would be buried. One evening after dark, several residents of Tours carried Martin's body to a waiting boat on the river Loire, where teams of rowers ferried his body on the river to Tours, where a huge throng of people waited on the river banks to meet and pay their last respects to Martin's body. One chronicle states that “2,000 monks, and nearly as many white-robed virgins, walked in the procession” accompanying the body from the river to a small grove outside of Tours, where Martin was buried.


title: Martin of Tours

text: The Abbey of Marmoutier was a monastery just outside today's city of Tours in Indre-et-Loire, France established by Martin around 372. Martin founded the monastery to escape attention and live life as a monastic. The Abbey at Tours was one of the most prominent and influential establishments in medieval France. Charlemagne awarded the position of Abbot to his friend and adviser Alcuin.


title: Martin of Tours

text: At this time the abbot could travel between Tours and the court at Trier in Germany and always stay overnight at one of his own properties. It was at Tours that Alcuin's scriptorium (a room in monasteries devoted to the copying of manuscripts by monastic scribes) developed Caroline minuscule, the clear round hand that made manuscripts far more legible.


title: Martin of Tours

text: In later times the abbey was destroyed by fire on several occasions and ransacked by Norman Vikings in 853 and in 903. It burned again in 994, and was rebuilt by Hervé de Buzançais, treasurer of Saint Martin, an effort that took 20 years to complete. Expanded to accommodate the crowds of pilgrims and to attract them, the shrine of St. Martin of Tours became a major stopping-point on pilgrimages. In 1453 the remains of Saint Martin were transferred to a magnificent new reliquary donated by Charles VII of France and Agnes Sorel.


title: Martin of Tours

text: During the French Wars of Religion, the basilica was sacked by the Protestant Huguenots in 1562. It was disestablished during the French Revolution. It was deconsecrated, used as a stable, then utterly demolished. Its dressed stones were sold in 1802 after two streets were built across the site, to ensure the abbey would not be reconstructed.


title: Martin of Tours

text: While Martin was a soldier in the Roman army and stationed in Gaul (modern-day France), he experienced a vision, which became the most-repeated story about his life. One day as he was approaching the gates of the city of Amiens, he met a scantily clad beggar. He impulsively cut his military cloak in half to share with the man. That night, Martin dreamed of Jesus wearing the half-cloak he had given away. He heard Jesus say to the angels: "Martin, who is still but a catechumen, clothed me with this robe." (Sulpicius, ch 2). In another version, when Martin woke, he found his cloak restored to wholeness. The dream confirmed Martin in his piety, and he was baptised at the age of 18.


title: Martin of Tours

text: The part kept by himself became the famous relic preserved in the oratory of the Merovingian kings of the Franks at the Marmoutier Abbey near Tours. During the Middle Ages, the supposed relic of St. Martin's miraculous cloak ("cappa Sancti Martini") was carried by the king even into battle, and used as a holy relic upon which oaths were sworn. The cloak is first attested to in the royal treasury in 679, when it was conserved at the "palatium" of Luzarches, a royal villa that was later ceded to the monks of Saint-Denis by Charlemagne, in 798/99.


title: Martin of Tours

text: The priest who cared for the cloak in its reliquary was called a "cappellanu", and ultimately all priests who served the military were called "cappellani". The French translation is "chapelains", from which the English word "chaplain" is derived.


title: Martin of Tours

text: A similar linguistic development took place for the term referring to the small temporary churches built for the relic. People called them a "capella", the word for a little cloak. Eventually, such small churches lost their association with the cloak, and all small churches began to be referred to as "chapels".


title: Martin of Tours

text: The veneration of Martin was widely popular in the Middle Ages, above all in the region between the Loire and the Marne, where Le Roy Ladurie and Zysberg noted the densest accretion of place names commemorating Martin. Venantius Fortunatus had earlier declared, "Wherever Christ is known, Martin is honored."


title: Martin of Tours

text: When Bishop Perpetuus took office at Tours in 461, the little chapel over Martin's grave, built in the previous century by Martin's immediate successor, Bricius, was no longer sufficient for the crowd of pilgrims it was already drawing. Perpetuus built a larger basilica, long and wide, with 120 columns. Martin's body was taken from the simple chapel at his hermitage at Candes-St-Martin to Tours and his sarcophagus was reburied behind the high altar of the new basilica. A large block of marble above the tomb, the gift of bishop Euphronius of Autun (472–475), rendered it visible to the faithful gathered behind the high altar. Werner Jacobsen suggests it may also have been visible to pilgrims encamped in the atrium of the basilica. Contrary to the usual arrangement, the atrium was situated behind the church, close to the tomb in the apse, which may have been visible through a "fenestrella" in the apse wall.


title: Martin of Tours

text: St. Martin's popularity can be partially attributed to his adoption by successive royal houses of France. Clovis, King of the Salian Franks, one of many warring tribes in sixth-century France, promised his Christian wife Clotilda that he would be baptised if he was victorious over the Alemanni. He credited the intervention of St Martin with his success, and with several following triumphs, including the defeat of Alaric II. The popular devotion to St Martin continued to be closely identified with the Merovingian monarchy: in the early seventh century Dagobert I commissioned the goldsmith Saint Eligius to make a work in gold and gems for the tomb-shrine. The bishop Gregory of Tours wrote and distributed an influential "Life" filled with miraculous events of St. Martin's career. Martin's "cultus" survived the passage of power to the Merovingians' successors, the Carolingian dynasty.


title: Martin of Tours

text: In 1860 excavations by Leo Dupont (1797–1876) established the dimensions of the former abbey and recovered some fragments of architecture. The tomb of St. Martin was rediscovered on 14 December 1860, which aided in the nineteenth-century revival of the popular devotion to St. Martin.


title: Martin of Tours

text: After the radical Paris Commune of 1871, there was a resurgence of conservative Catholic piety, and the church decided to build a basilica to St. Martin. They selected Victor Laloux as architect. He eschewed Gothic for a mix of Romanesque and Byzantine, sometimes defined as neo-Byzantine. The new Basilique Saint-Martin was erected on a portion of its former site, which was purchased from the owners. Started in 1886, the church was consecrated 4 July 1925.


title: Martin of Tours

text: Martin's renewed popularity in France was related to his promotion as a military saint during the Franco-Prussian War of 1870–1871.


title: Martin of Tours

text: During the military and political crisis of the Franco-Prussian war, Napoleon III's Second Empire collapsed. After the surrender of Napoleon to the Prussians after the Battle of Sedan in September 1870, a provisional government of national defense was established, and France's Third Republic was proclaimed. Paris was evacuated due to the advancing enemy and for a brief time (September–December 1870), Tours became the effective capital of France.


title: Martin of Tours

text: St Martin was promoted by the clerical right as the protector of the nation against the German threat. Conservatives associated the dramatic collapse of Napoleon III's regime as a sign of divine retribution on the irreligious emperor. Priests interpreted it as punishment for a nation led astray due to years of anti-clericalism. They preached repentance and a return to religion for political stability. The ruined towers of the old royal basilica of St. Martin at Tours came to symbolize the decline of traditional Catholic France.


title: Martin of Tours

text: With the government's relocation to Tours during the Franco-Prussian War, 1870, numerous pilgrims were attracted to St. Martin's tomb. It was covered by a temporary chapel built by archbishop Guibert. The popular devotion to St. Martin was also associated with the nationalistic devotion to the Sacred Heart. The flag of Sacre-Coeur, borne by Ultramontane Catholic Pontifical Zouaves who fought at Patay, had been placed overnight in St. Martin's tomb before being taken into battle on 9 October 1870. The banner read "Heart of Jesus Save France" and on the reverse side Carmelite nuns of Tours embroidered "Saint Martin Protect France".As the French army was victorious in Patay, many among the faithful took the victory to be the result of divine favor. Popular hymns of the 1870s developed the theme of national protection under the cover of Martin's cloak, the "first flag of France".


title: Martin of Tours

text: During the nineteenth-century Frenchmen, influenced by secularism, agnosticism, and anti-clericalism, deserted the church in great numbers. As Martin was a man's saint, the devotion to him was an exception to this trend. For men serving in the military, Martin of Tours was presented by the Catholic Right as the masculine model of principled behavior. He was a brave fighter, knew his obligation to the poor, shared his goods, performed his required military service, followed legitimate orders, and respected secular authority.


title: Martin of Tours

text: During the 1870s, the procession to St. Martin's tomb at Tours became a display of ecclesiastical and military cooperation. Army officers in full uniform acted as military escorts, symbolically protecting the clergy and clearing the path for them. Anti-clerics viewed the staging of public religious processions as a violation of civic space. In 1878, M. Rivière, the provisional mayor of Tours, with anticlerical support banned the November procession in honor of St. Martin. President Patrice de Mac-Mahon was succeeded by the Republican Jules Grévy, who created a new national anticlerical offensive. Bishop Louis-Édouard-François-Desiré Pie of Poitiers united conservatives and devised a massive demonstration for the November 1879 procession. Pie's ultimate hope was that St Martin would stop the “chariot” of modern society, and lead to the creation of a France where the religious and secular sectors merged.


title: Martin of Tours

text: The struggle between the two men was reflective of that between conservatives and anti-clerics over the church's power in the army. From 1874, military chaplains were allowed in the army in times of peace, but anti-clerics viewed the chaplains as sinister monarchists and counter-revolutionaries. Conservatives responded by creating the short-lived Legion de Saint Maurice in 1878 and the society, Notre Dame de Soldats, to provide unpaid voluntary chaplains with financial support. The legislature passed the anticlerical Duvaux Bill of 1880, which reduced the number of chaplains in the French army. Anticlerical legislators wanted commanders, not chaplains, to provide troops with moral support and to supervise their formation in the established faith of "patriotic Republicanism."


title: Martin of Tours

text: St. Martin has long been associated with France's royal heritage. Monsignor René François Renou (Archbishop of Tours, 1896–1913) worked to associate St. Martin as a specifically "republican" patron. Renou had served as a chaplain to the 88 Régiment des mobils d'Indre-et-Loire during the Franco-Prussian war and was known as the "army bishop." Renou was a strong supporter of St. Martin and believed that the national destiny of France and all its victories were attributed to him. He linked the military to the cloak of St. Martin, which was the "first flag of France" to the French tricolor, "the symbol of the union of the old and new." This flag symbolism connected the devotion to St. Martin with the Third Republic. But, the tensions of the Dreyfus Affair renewed anti-clericalism in France and drove a wedge between the Church and the Republic. By 1905, the influence of Rene Waldeck-Rousseau and Emile Combes, combined with deteriorating relations with the Vatican, led to the separation of church and state.


title: Martin of Tours

text: St. Martin's popularity was renewed during the First World War. Anticlericalism declined, and priests served in the French forces as chaplains. More than 5,000 of them died in the war. In 1916, Assumptionists organized a national pilgrimage to Tours that attracted people from all of France. The devotion to St. Martin was amplified in the dioceses of France, where special prayers were offered to the patron saint. When the armistice was signed on Saint Martin's Day, 11 November 1918, the French people saw it was a sign of his intercession in the affairs of France.


title: Martin of Tours

text: He is the patron saint of beggars (because of his sharing his cloak), wool-weavers and tailors (also because of his cloak), he is also the patron saint of the US Army Quartermaster Corps even though he detested violence (also because of sharing his cloak), geese (some say because they gave his hiding place away when he tried to avoid being chosen as bishop, others because their migration coincides with his feast), vintners and innkeepers (because his feast falls just after the late grape harvest), and France. He was proclaimed patron of Italian volunteering by the Italian bishops in the spring of 2021.


title: Martin of Tours

text: Beyond his patronage of the French Third Republic, Saint Martin more recently has also been described in terms of "a spiritual bridge across Europe" due to his "international" background, being a native of Pannonia who spent his adult life in Gaul.


title: Martin of Tours

text: Martin is most generally portrayed on horseback dividing his cloak with the beggar. His emblem in English art is often that of a goose, whose annual migration is about late autumn.


title: Martin of Tours

text: The Museum Catharijneconvent in Utrecht has a relic in its collection which is called "the hammer of St. Martin of Tours" (Latin: "maleus beati Martini"). It was made in the 13th or 14th century from a late Bronze Age stone axe from c. 1,000 – 700 BC, though the dating is uncertain. The grip contains a Latin text saying ""Ydola vanurunt Martini cesa securi nemo deos credat qui sic fuerant ruicuri"" ("the pagan statues fall down, hit by St. Martin's axe. Let nobody believe that those are gods, who so easily fall down"). Legend says that the axe belonged to St. Martin, and was used to hit the devil and to destroy the heathen temples and statues.


title: Martin of Tours

text: By the early 9th century, respect for Saint Martin was well-established in Ireland. His monastery at Marmoûtiers became the training ground for many Celtic missions and missionaries. Some believe that St. Patrick was his nephew and that Patrick was one of many Celtic notables who lived for a time at Marmoûtiers. St. Ninian definitely studied at Marmoûtiers and was profoundly influenced by Martin, carrying a deep love and respect for his teacher and his methods back to Scotland. Ninian was in the process of building a church when news reached him of Martin's death. Ninian dedicated that church to Martin.


title: Martin of Tours

text: The Book of Armagh contains three distinct groups of material: (1) a complete text of the New Testament, (2) a dossier of materials on Saint Patrick, and (3) almost the complete body of writings on Saint Martin by Sulpicius Severus.


title: Martin of Tours

text: In Jonas of Bobbio's "Vita Columbani", Jonas relates that Saint Columbanus, while travelling, requested to be allowed to pray at the tomb of St Martin. The Irish palimpsest sacramentary from the mid-7th century contains the text of a mass for St Martin. In the "Life of Columba", Adamnan mentions in passing that St Martin was commemorated during Mass at Iona.


title: Martin of Tours

text: In his "Ireland and Her Neighbours in the Seventh Century", Michael Richter attributes this to the mission of Palladius seen within the wider context of the mission of Germanus of Auxerre to Britain around 429. Thus, this could be the context in which the Life of St Martin was brought from Gaul to Ireland at an early date, and could explain how Columbanus was familiar with it before he ever left Ireland.


title: Martin of Tours

text: Founded by Martin of Tours in 360, Ligugé Abbey is one of the earliest monastic foundations in France. The reputation of the founder attracted a large number of disciples to the new monastery; the disciples initially living in locaciacum or small huts, this name later evolved to Ligugé. Its reputation was soon eclipsed by Martin's later foundation at Marmoutier. As of 2013, the Benedictine community at Ligugé numbered twenty-five.


title: Martin of Tours

text: From the late 4th century to the late Middle Ages, much of Western Europe, including Great Britain, engaged in a period of fasting beginning on the day after St. Martin's Day, November 11. This fast period lasted 40 days (not including Saturdays and Sundays), and was, therefore, called "Quadragesima Sancti Martini", which means in Latin "the forty days of St. Martin". At St. Martin's eve and on the feast day, people ate and drank very heartily for a last time before they started to fast. This fasting time was later called "Advent" by the Church and was considered a time for spiritual preparation for Christmas.


title: Martin of Tours

text: On St. Martin's Day, children in Flanders, the southern and northern parts of the Netherlands, and the Catholic areas of Germany and Austria still participate in paper lantern processions. Often, a man dressed as St. Martin rides on a horse in front of the procession. The children sing songs about St. Martin and about their lanterns. The food traditionally eaten on the day is goose, a rich bird. According to legend, Martin was reluctant to become bishop, which is why he hid in a stable filled with geese. The noise made by the geese betrayed his location to the people who were looking for him.


title: Martin of Tours

text: In the eastern part of the Belgian province of East Flanders (Aalst) and the western part of West Flanders (Ypres), traditionally children receive presents from St. Martin on November 11, instead of from Saint Nicholas on December 6 or Santa Claus on December 25. They also have lantern processions, for which children make lanterns out of beets. In recent years, the lantern processions have become widespread as a popular ritual, even in Protestant areas of Germany and the Netherlands. Most Protestant churches no longer officially recognize Saints.


title: Martin of Tours

text: In Portugal, where the saint's day is celebrated across the country, it is common for families and friends to gather around the fire in reunions called "magustos", where they typically eat roasted chestnuts and drink wine, "jeropiga" (a drink made of grape must and aguardente) and "aguapé" (a sort of weak and watered-down wine). According to the most widespread variation of the cloak story, Saint Martin cut off half of his cloak in order to offer it to a beggar and along the way, he gave the remaining part to a second beggar. As he faced a long ride in a freezing weather, the dark clouds cleared away and the sun shone so intensely that the frost melted away. Such weather was rare for early November, so was credited to God's intervention. The phenomenon of a sunny break to the chilly weather on Saint Martin's Day (11 November) is called "Verão de São Martinho" (Saint Martin's Summer, "veranillo de san Martín" in Spanish) in honor of the cloak legend.


title: Martin of Tours

text: In Malta on the night of the eve of Saint Martin's day children leave an empty bag next to the bed. This bag is found full of fruit on the next day.


title: Martin of Tours

text: Many churches are named after Saint Martin of Tours. St Martin-in-the-fields, at Trafalgar Square in the centre of London, has a history appropriately associated with Martin's renunciation of war; Dick Sheppard, founder of the Peace Pledge Union, was Vicar 1914–26, and there is a memorial chapel for him, with a plaque for Vera Brittain, also a noted Anglican pacifist; the steps of the church are often used for peace vigils. Saint Martin's Cathedral, in Ypres, Belgium, is dedicated to him. St. Martin is the patron saint of Szombathely, Hungary, with a church dedicated to him, and also the patron saint of Buenos Aires. In the Netherlands, he is the patron of the cathedral and city of Utrecht. He is the patron of the city of Groningen; its Martini tower and Martinikerk (Groningen) (Martin's Church) were named for him.


title: Martin of Tours

text: St. Martin's Church in Kaiserslautern, Germany is a major city landmark. It is located in the heart of the city's downtown in St. Martin's Square, and is surrounded by a number of restaurants and shops. The church was originally built as a Franciscan monastery in the 14th century and has a number of unique architectural features.


title: Martin of Tours

text: St. Martin is the patron saint of the Polish towns of Bydgoszcz and Opatów. His day is celebrated with a procession and festivities in the city of Poznań, where the main street ("Święty Marcin") is named for him, after a 13th-century church in his honor. A special type of crescent cake ("rogal świętomarciński") is baked for the occasion. As November 11 is also Polish Independence Day, it is a public holiday.


title: Martin of Tours

text: The Monastery of Saint Martin of Castañeda has been a national historic monument since 1931. It is located in Galende, Sanabria, province of Zamora, Spain. It now functions as an interpretation center.


title: Martin of Tours

text: In Latin America, St. Martin has a strong popular following and is frequently referred to as San Martín Caballero, in reference to his common depiction on horseback. Mexican folklore believes him to be a particularly helpful saint toward business owners.


title: Martin of Tours

text: The largest Anglican church in North America is St Martin's Episcopal in Houston, Texas. It was the home church for many years of President and Mrs. George H. W. Bush and still is for former Secretary of State and Treasury James Baker and his wife Susan.


title: Martin of Tours

text: San Martín de Loba is the name of a municipality in the Bolívar Department of Colombia. Saint Martin, as San Martín de Loba, is the patron saint of Vasquez, a small village in Colombia.


title: Martin of Tours

text: In Finland, the town and municipality Marttila ("S:t Mårtens" in Swedish) is named after St. Martin and depicts him on its coat of arms.


title: Martin of Tours

text: Though no mention of St. Martin's connection with viticulture is made by Gregory of Tours or other early hagiographers, he is now credited with a prominent role in spreading wine-making throughout the Touraine region and the planting of many vines. The Greek myth that Aristaeus first discovered the concept of pruning the vines, after watching a goat eat some of the foliage, has been adopted for Martin. He is also credited with introducing the Chenin blanc grape varietal, from which most of the white wine of western Touraine and Anjou is made.


title: Martin of Tours

text: Martin Luther was named after St. Martin, as he was baptised on November 11 (St. Martin's Day), 1483. Many older Lutheran congregations are named after St. Martin, which is unusual (for Lutherans) because he is a saint who does not appear in the Bible. (Lutherans regularly name congregations after the evangelists and other saints who appear in the Bible but are hesitant to name congregations after post-Biblical saints.)


title: Martin of Tours

text: Martin of Tours is the patron saint of the U.S. Army Quartermaster Corps, which has a medal in his name. The Church Lads' and Church Girls' Brigade, a 5–7 age group, was renamed 'Martins' in his honour in 1998.


title: Martin of Tours

text: Many schools have St Martin as their Patron, one being St. Martin's School (Rosettenville) in Johannesburg.


title: Martin of Tours

text: The Dutch film "Flesh and Blood" (1985) prominently features a statue of Saint Martin. A mercenary in Renaissance Italy, named Martin, finds a statue of Saint Martin cutting his cloak and takes it as a sign to desert and rogue around under the saint's protection.


title: Maternal death

text: Maternal death or maternal mortality is defined in slightly different ways by several different health organizations. The World Health Organization (WHO) defines maternal death as the death of a pregnant mother due to complications related to pregnancy, underlying conditions worsened by the pregnancy or management of these conditions. This can occur either while they are pregnant or within six weeks of resolution of the pregnancy. The CDC definition of pregnancy-related deaths extends the period of consideration to include one year from the resolution of the pregnancy. Pregnancy associated death, as defined by the American College of Obstetricians and Gynecologists (ACOG), are all deaths occurring within one year of a pregnancy resolution. Identification of pregnancy associated deaths is important for deciding whether or not the pregnancy was a direct or indirect contributing cause of the death.


title: Maternal death

text: There are two main measures used when talking about the rates of maternal mortality in a community or country. These are the maternal mortality ratio and maternal mortality rate, both abbreviated as "MMR". By 2017, the world maternal mortality rate had declined 44% since 1990; however, every day 808 women die from pregnancy or childbirth related causes. According to the United Nations Population Fund (UNFPA) 2017 report, about every 2 minutes a woman dies because of complications due to child birth or pregnancy. For every woman who dies, there are about 20 to 30 women who experience injury, infection, or other birth or pregnancy related complication.


title: Maternal death

text: UNFPA estimated that 303,000 women died of pregnancy or childbirth related causes in 2015. The WHO divides causes of maternal deaths into two categories: direct obstetric deaths and indirect obstetric deaths. Direct obstetric deaths are causes of death due to complications of pregnancy, birth or termination. For example, these could range from severe bleeding to obstructed labor, for which there are highly effective interventions. Indirect obstetric deaths are caused by pregnancy interfering or worsening an existing condition, like a heart problem.


title: Maternal death

text: As women have gained access to family planning and skilled birth attendant with backup emergency obstetric care, the global maternal mortality ratio has fallen from 385 maternal deaths per 100,000 live births in 1990 to 216 deaths per 100,000 live births in 2015. Many countries halved their maternal death rates in the last 10 years. Although attempts have been made to reduce maternal mortality, there is much room for improvement, particularly in low-resource regions. Over 85% of maternal deaths are in low-resource communities in Africa and Asia. In higher resource regions, there are still significant areas with room for growth, particularly as they relate to racial and ethnic disparities and inequities in maternal mortality and morbidity rates.


title: Maternal death

text: Overall, maternal mortality is an important marker of the overall health of the country and reflects on its health infrastructure. Lowering the amount of maternal death is an important goal of many health organizations world-wide.


title: Maternal death

text: Direct obstetric deaths are due to complications of pregnancy, birth, termination or complications arising from their management.


title: Maternal death

text: The causes of maternal death vary by region and level of access. According to a study published in the "Lancet" which covered the period from 1990 to 2013, the most common causes of maternal death world-wide are postpartum bleeding (15%), complications from unsafe abortion (15%), hypertensive disorders of pregnancy (10%), postpartum infections (8%), and obstructed labor (6%). Other causes include blood clots (3%) and pre-existing conditions (28%).


title: Maternal death

text: Postpartum bleeding happens when there is uncontrollable bleeding from the uterus, cervix or vaginal wall after birth. This can happen when the uterus does not contract correctly after birth, there is left over placenta in the uterus, or there are cuts in the cervix or vagina from birth.


title: Maternal death

text: Hypertensive disorders of pregnancy happen when the body does not regulate blood pressure correctly. In pregnancy, this is due to changes at the level of the blood vessels, likely because of the placenta. This includes medical conditions like gestational hypertension and pre-eclampsia.


title: Maternal death

text: Postpartum infections are infections of the uterus or other parts of the reproductive tract after the resolution of a pregnancy. They are usually bacterial and cause fever, increased pain, and foul-smelling discharge.


title: Maternal death

text: Obstructed labor happens when the baby does not properly move into the pelvis and out of the body during labor. The most common cause of obstructed labor is when the baby's head is too big or angled at a way that does not allow it to pass through the pelvis and birth canal.


title: Maternal death

text: Blood clots can occur in different vessels in the body, including vessels in the arms, legs, and lungs. They can cause problems in the lung, as well as travel to the heart or brain, leading to complications.


title: Maternal death

text: When abortion is legal and accessible, it is widely regarded as safer than carrying a pregnancy to term and delivery. In fact, a study published in the journal Obstetrics & Gynecology reported that in the United States, carrying a pregnancy to term and delivering a baby comes with 14 times increased risk of death as compared to a legal abortion. However, in many regions of the world, abortion is not legal and can be unsafe. Maternal deaths caused by improperly performed procedures are preventable and contribute 13% to the maternal mortality rate worldwide. This number is increased to 25% in countries where other causes of maternal mortality are low, such as in Eastern European and South American countries. This makes unsafe abortion practices the leading cause of maternal death worldwide.


title: Maternal death

text: Unsafe abortion is another major cause of maternal death worldwide. In regions where abortion is legal and accessible, abortion is safe and does not contribute greatly to overall rates of maternal death. However, in regions where abortions are not legal, available, or regulated, unsafe abortion practices can cause significant rates of maternal death. According to the World Health Organization in 2009, every eight minutes a woman died from complications arising from unsafe abortions.


title: Maternal death

text: Unsafe abortion practices are defined by the WHO as procedures that are performed by someone without the appropriate training and/or ones that are performed in an environment that is not considered safe or clean. Using this definition, the WHO estimates that out of the 45 million abortions that are performed each year globally, 19 million of these are considered unsafe, and 97% of these unsafe abortions occur in developing countries. Complications include hemorrhage, infection, sepsis and genital trauma.


title: Maternal death

text: There are four primary types of data sources that are used to collect abortion-related maternal mortality rates: confidential enquiries, registration data, verbal autopsy, and facility-based data sources. A verbal autopsy is a systematic tool that is used to collect information on the cause of death from laypeople and not medical professionals.


title: Maternal death

text: Confidential enquires for maternal deaths do not occur very often on a national level in most countries. Registration systems are usually considered the "gold-standard" method for mortality measurements. However, they have been shown to miss anywhere between 30 and 50% of all maternal deaths. Another concern for registration systems is that 75% of all global births occur in countries where vital registration systems do not exist, meaning that many maternal deaths occurring during these pregnancies and deliveries may not be properly record through these methods. There are also issues with using verbal autopsies and other forms of survey in recording maternal death rates. For example, the family's willingness to participate after the loss of a loved one, misclassification of the cause of death, and under-reporting all present obstacles to the proper reporting of maternal mortality causes. Finally, an potential issue with facility-based data collection on maternal mortality is the likelihood that women who experience abortion-related complications to seek care in medical facilities. This is due to fear of social repercussions or legal activity in countries where unsafe abortion is common since it is more likely to be legally restrictive and/or more highly stigmatizing. Another concern for issues related to errors in proper reporting for accurate understanding of maternal mortality is the fact that global estimates of maternal deaths related to a specific cause present those related to abortion as a proportion of the total mortality rate. Therefore, any change, whether positive or negative, in the abortion-related mortality rate is only compared relative to other causes, and this does not allow for proper implications of whether abortions are becoming more safe or less safe with respect to the overall mortality of women.


title: Maternal death

text: The prevention and reduction of maternity death is one of the United Nations' Sustainable Development Goals, specifically Goal 3, "Good health and well being". Promoting effective contraceptive use and information distributed to a wider population, with access to high-quality care, can make steps towards reducing the number of unsafe abortions. For nations that allow contraceptives, programs should be instituted to allow the easier accessibility of these medications. However, this alone will not eliminate the demand for safe services, awareness on safe abortion services, health education on prenatal check ups and proper implementation of diets during pregnancy and lactation also contributes to its prevention.


title: Maternal death

text: Indirect obstetric deaths are caused by preexisting health problem worsened by pregnancy or newly developed health problem unrelated to pregnancy . Fatalities during but unrelated to a pregnancy are termed "accidental", "incidental", or non-obstetrical maternal deaths.


title: Maternal death

text: Indirect causes include malaria, anemia, HIV/AIDS, and cardiovascular disease, all of which may complicate pregnancy or be aggravated by it. Risk factors associated with increased maternal death include the age of the mother, obesity before becoming pregnant, other pre-existing chronic medical conditions, and cesarean delivery.


title: Maternal death

text: According to a 2004 WHO publication, sociodemographic factors such as age, access to resources and income level are significant indicators of maternal outcomes. Young mothers face higher risks of complications and death during pregnancy than older mothers, especially adolescents aged 15 years or younger. Adolescents have higher risks for postpartum hemorrhage, endometritis, operative vaginal delivery, episiotomy, low birth weight, preterm delivery, and small-for-gestational-age infants, all of which can lead to maternal death. The leading cause of death for girls at the age of 15 in developing countries is complication through pregnancy and childbirth. They have more pregnancies, on average, than women in developed countries, and it has been shown that 1 in 180 15-year-old girls in developing countries who become pregnant will die due to complications during pregnancy or childbirth. This is compared to women in developed countries, where the likelihood is 1 in 4900 live births. However, in the United States, as many women of older age continue to have children, the maternal mortality rate has risen in some states, especially among women over 40 years old.


title: Maternal death

text: Structural support and family support influences maternal outcomes. Furthermore, social disadvantage and social isolation adversely affects maternal health which can lead to increases in maternal death. Additionally, lack of access to skilled medical care during childbirth, the travel distance to the nearest clinic to receive proper care, number of prior births, barriers to accessing prenatal medical care and poor infrastructure all increase maternal deaths.


title: Maternal death

text: Pregnancy-related deaths between 2011 and 2014 in the United States have been shown to have major contributions from non-communicable diseases and conditions, and the following are some of the more common causes related to maternal death: cardiovascular diseases (15.2%.), non-cardiovascular diseases (14.7%), infection or sepsis (12.8%), hemorrhage (11.5%), cardiomyopathy (10.3%), pulmonary embolism (9.1%), cerebrovascular accidents (7.4%), hypertensive disorders of pregnancy (6.8%), amniotic fluid embolism (5.5%), and anesthesia complications (0.3%).


title: Maternal death

text: The three delays model addresses three critical factors that inhibit women from receiving appropriate maternal health care. These factors include:


title: Maternal death

text: Delays in seeking care are due to the decisions made by the women who are pregnant and/or other decision-making individuals. Decision-making individuals can include a spouse and family members. Examples of reasons for delays in seeking care include lack of knowledge about when to seek care, inability to afford health care, and women needing permission from family members.


title: Maternal death

text: Delays in reaching care include factors such as limitations in transportation to a medical facility, lack of adequate medical facilities in the area, and lack in confidence in medicine.


title: Maternal death

text: Delays in receiving adequate and appropriate care may result from an inadequate number of trained providers, lack of appropriate supplies, and the lack of urgency or understanding of an emergency.


title: Maternal death

text: The three delays model illustrates that there are a multitude of complex factors, both socioeconomic and cultural, that can result in maternal death.


title: Maternal death

text: The four measures of maternal death are the maternal mortality ratio (MMR), maternal mortality rate, lifetime risk of maternal death and proportion of maternal deaths among deaths of women of reproductive years (PM).


title: Maternal death

text: Maternal mortality ratio (MMR) is the ratio of the number of maternal deaths during a given time period per 100,000 live births during the same time-period. The MMR is used as a measure of the quality of a health care system.


title: Maternal death

text: Maternal mortality rate (MMRate) is the number of maternal deaths in a population divided by the number of women of reproductive age, usually expressed per 1,000 women.


title: Maternal death

text: Lifetime risk of maternal death is a calculated prediction of a woman's risk of death after each consecutive pregnancy. The calculation pertains to women during their reproductive years. The adult lifetime risk of maternal mortality can be derived using either the maternal mortality ratio (MMR), or the maternal mortality rate (MMRate).


title: Maternal death

text: the number of maternal deaths in a given time period divided by the total deaths among women aged 15–49 years.


title: Maternal death

text: Approaches to measuring maternal mortality include civil registration system, household surveys, census, reproductive age mortality studies (RAMOS) and verbal autopsies. The most common household survey method, recommended by the WHO as time- and cost-effective, is the sisterhood method.


title: Maternal death

text: The United Nations Population Fund (UNFPA; formerly known as the United Nations Fund for Population Activities) have established programs that support efforts in reducing maternal death. These efforts include education and training for midwives, supporting access to emergency services in obstetric and newborn care networks, and providing essential drugs and family planning services to pregnant women or those planning to become pregnant. They also support efforts for review and response systems regarding maternal deaths.


title: Maternal death

text: According to the 2010 United Nations Population Fund report, low-resource nations account for ninety-nine percent of maternal deaths with the majority of those deaths occurring in Sub-Saharan Africa and Southern Asia. Globally, high and middle income countries experience lower maternal deaths than low income countries. The Human Development Index (HDI) accounts for between 82 and 85 percent of the maternal mortality rates among countries. In most cases, high rates of maternal deaths occur in the same countries that have high rates of infant mortality. These trends are a reflection that higher income countries have stronger healthcare infrastructure, more doctors, use more advanced medical technologies and have fewer barriers to accessing care than low income countries. In low income countries, the most common cause of maternal death is obstetrical hemorrhage, followed by hypertensive disorders of pregnancy. This is contrast to high income countries, for which the most common cause is thromboembolism.


title: Maternal death

text: Between 1990 and 2015, the maternal mortality ratio has decreased from 385 deaths per 100,000 live births to 216 maternal deaths per 100,000 live births. Some factors that have been attributed to the decreased maternal deaths seen between this period are in part to the access that women have gained to family planning services and skilled birth attendance, meaning a midwife, doctor, or trained nurse), with back-up obstetric care for emergency situations that may occur during the process of labor. This can be examined further by looking at statistics in some areas of the world where inequities in access to health care services reflect an increased number of maternal deaths. The high maternal death rates also reflect disparate access to health services between resource communities and those that are high-resource or affluent.


title: Maternal death

text: The disparities in maternal health outcomes are also present among racial groups. In the United States, black women are 3-4 times more likely to die from maternal mortality than white women. Unequal access to quality medical care, socioeconomic disparities, and systemic racism by health care providers are factors that have contributed to the high maternal mortality rates among black women.


title: Maternal death

text: According to UNFPA, there are four essential elements for prevention of maternal death. These include, prenatal care, assistance with birth, access to emergency obstetric care and adequate postnatal care. It is recommended that expectant mothers receive at least four antenatal visits to check and monitor the health of mother and fetus. Second, skilled birth attendance with emergency backup such as doctors, nurses and midwives who have the skills to manage normal deliveries and recognize the onset of complications. Third, emergency obstetric care to address the major causes of maternal death which are hemorrhage, sepsis, unsafe abortion, hypertensive disorders and obstructed labor. Lastly, postnatal care which is the six weeks following delivery. During this time, bleeding, sepsis and hypertensive disorders can occur, and newborns are extremely vulnerable in the immediate aftermath of birth. Therefore, follow-up visits by a health worker to assess the health of both mother and child in the postnatal period is strongly recommended.


title: Maternal death

text: Additionally, reliable access to information, compassionate counseling and quality services for the management of any issues that arise from abortions (whether safe or unsafe) can be beneficial in reducing the number of maternal deaths. In regions where abortion is legal, abortion practices need to be safe in order to effectively reduce the number of maternal deaths related to abortion.


title: Maternal death

text: Maternal Death Surveillance and Response is another strategy that has been used to prevent maternal death. This is one of the interventions proposed to reduce maternal mortality where maternal deaths are continuously reviewed to learn the causes and factors that led to the death. The information from the reviews is used to make recommendations for action to prevent future similar deaths. Maternal and perinatal death reviews have been in practice for a long time worldwide, and the World Health Organization (WHO) introduced the Maternal and Perinatal Death Surveillance and Response (MPDSR) with a guideline in 2013. Studies have shown that acting on recommendations from MPDSR can reduce maternal and perinatal mortality by improving quality of care in the community and health facilities.


title: Maternal death

text: It was estimated that in 2015, a total of 303,000 women died due to causes related to pregnancy or childbirth. The majority of these were due to severe bleeding, sepsis or infections, eclampsia, obstructed labor, and consequences from unsafe abortions. Most of these causes are either preventable or have highly effective interventions. An important factor that contributes to the maternal mortality rate is access and opportunity to receive prenatal care. Women who do not receive prenatal care are between three and four times more likely to die from complications resulting from pregnancy or delivery than those who receive prenatal care. Even in high-resource countries, many women do not receive the appropriate preventative or prenatal care. For example, 25% of women in the United States do not receive the recommended number of prenatal visits. This number increases for women among traditionally marginalized populations—32% of African American women and 41% for American Indian and Alaska Native women do not receive the recommended preventative health services prior to delivery.


title: Maternal death

text: The decline in maternal deaths has been due largely to improved aseptic techniques, better fluid management and quicker access to blood transfusions, and better prenatal care.


title: Maternal death

text: Technologies have been designed for resource poor settings that have been effective in reducing maternal deaths as well. The non-pneumatic anti-shock garment is a low-technology pressure device that decreases blood loss, restores vital signs and helps buy time in delay of women receiving adequate emergency care during obstetric hemorrhage. It has proven to be a valuable resource. Condoms used as uterine tamponades have also been effective in stopping post-partum hemorrhage.


title: Maternal death

text: Some maternal deaths can be prevented through medication use. Injectable oxytocin can be used to prevent death due to postpartum bleeding. Additionally, postpartum infections can be treated using antibiotics. In fact, the use of broad-spectrum antibiotics both for the prevention and treatment of maternal infection is common in low-income countries. Maternal death due to eclampsia can also be prevented through the use of medications such as magnesium sulfate.


title: Maternal death

text: Many complications can be managed with procedures and/or surgery if there is access to a qualified surgeon and appropriate facilities and supplies. For example, the contents of the uterus can be cleaned if there is concern for remaining pregnancy tissue or infection. If there is concern for excess bleeding, special ties, stitches or tools (Bakri Balloon) can be placed if there is concern for excess bleeding.


title: Maternal death

text: A public health approach to addressing maternal mortality includes gathering information on the scope of the problem, identifying key causes, and implementing interventions, both prior to pregnancy and during pregnancy, to combat those causes and prevent maternal mortality.


title: Maternal death

text: Public health has a role to play in the analysis of maternal death. One important aspect in the review of maternal death and its causes are Maternal Mortality Review Committees or Boards. The goal of these review committees are to analyze each maternal death and determine its cause. After this analysis, the information can be combined in order to determine specific interventions that could lead to preventing future maternal deaths. These review boards are generally comprehensive in their analysis of maternal deaths, examining details that include mental health factors, public transportation, chronic illnesses, and substance use disorders. All of this information can be combined to give a detailed picture of what is causing maternal mortality and help to determine recommendations to reduce their impact.


title: Maternal death

text: Many states within the US are taking Maternal Mortality Review Committees a step further and are collaborating with various professional organizations to improve quality of perinatal care. These teams of organizations form a "perinatal quality collaborative" (PQC) and include state health departments, the state hospital association and clinical professionals such as doctors and nurses. These PQCs can also involve community health organizations, Medicaid representatives, Maternal Mortality Review Committees and patient advocacy groups. By involving all of these major players within maternal health, the goal is to collaborate and determine opportunities to improve quality of care. Through this collaborative effort, PQCs can aim to make impacts on quality both at the direct patient care level and through larger system devices like policy. It is thought that the institution of PQCs in California was the main contributor to the maternal mortality rate decreasing by 50% in the years following. The PQC developed review guides and quality improvement initiatives aimed at the most preventable and prevalent maternal deaths: those due to bleeding and high blood pressure. Success has also been observed with PQCs in Illinois and Florida.


title: Maternal death

text: Several interventions prior to pregnancy have been recommended in efforts to reduce maternal mortality. Increasing access to reproductive healthcare services, such as family planning services and safe abortion practices, is recommended in order to prevent unintended pregnancies. Several countries, including India, Brazil, and Mexico, have seen some success in efforts to promote the use of reproductive healthcare services. Other interventions include high quality sex education, which includes pregnancy prevention and sexually transmitted infection (STI) prevention and treatment. By addressing STIs, this not only reduces perinatal infections, but can also help reduce ectopic pregnancy caused by STIs. Adolescent mothers are between two and five times more likely to die than a female twenty years or older. Access to reproductive services and sex education could make a large impact, specifically on adolescents, who are generally uneducated in regards to carrying a healthy pregnancy. Education level is a strong predictor of maternal health as it gives women the knowledge to seek care when it is needed. Public health efforts can also intervene during pregnancy to improve maternal outcomes. Areas for intervention have been identified in access to care, public knowledge, awareness about signs and symptoms of pregnancy complications, and improving relationships between healthcare professionals and expecting mothers.


title: Maternal death

text: Access to care during pregnancy is a significant issue in the face of maternal mortality. "Access" encompasses a wide range of potential difficulties including costs, location of healthcare services, availability of appointments, availability of trained health care workers, transportation services, and cultural or language barriers that could inhibit a woman from receiving proper care. For women carrying a pregnancy to term, access to necessary antenatal (prior to delivery) healthcare visits is crucial to ensuring healthy outcomes. These antenatal visits allow for early recognition and treatment of complications, treatment of infections and the opportunity to educate the expecting mother on how to manage her current pregnancy and the health advantages of spacing pregnancies apart.


title: Maternal death

text: Access to birth at a facility with a skilled healthcare provider present has been associated with safer deliveries and better outcomes. The two areas bearing the largest burden of maternal mortality, Sub-Saharan Africa and South Asia, also had the lowest percentage of births attended by a skilled provider, at just 45% and 41% respectively. Emergency obstetric care is also crucial in preventing maternal mortality by offering services like emergency cesarean sections, blood transfusions, antibiotics for infections and assisted vaginal delivery with forceps or vacuum. In addition to physical barriers that restrict access to healthcare, financial barriers also exist. Close to one out of seven women of child-bearing age have no health insurance. This lack of insurance impacts access to pregnancy prevention, treatment of complications, as well as perinatal care visits contributing to maternal mortality.


title: Maternal death

text: By increasing public knowledge and awareness through health education programs about pregnancy, including signs of complications that need addressed by a healthcare provider, this will increase the likelihood of an expecting mother to seek help when it is necessary. Higher levels of education have been associated with increased use of contraception and family planning services as well as antenatal care. Addressing complications at the earliest sign of a problem can improve outcomes for expecting mothers, which makes it extremely important for a pregnant woman to be knowledgeable enough to seek healthcare for potential complications. Improving the relationships between patients and the healthcare system as a whole will make it easier for a pregnant woman to feel comfortable seeking help. Good communication between patients and providers, as well as cultural competence of the providers, could also assist in increasing compliance with recommended treatments.


title: Maternal death

text: Another important preventive measure being implemented is specialized education for mothers. Doctors and medical professionals providing simple information to women, especially women in lower socioeconomic areas will decrease the miscommunication that often occurs between doctors and patients. Training health care professionals will be another important aspect in decreasing the rate of maternal death, "The study found that white medical students and residents often believed incorrect and sometimes 'fantastical' biological fallacies about racial differences in patients. For these assumptions, researchers blamed not individual prejudice but deeply ingrained unconscious stereotypes about people of color, as well as physicians' difficulty in empathizing with patients whose experiences differ from their own."


title: Maternal death

text: The biggest global policy initiative for maternal health came from the United Nations' Millennium Declaration which created the Millennium Development Goals. In 2012, this evolved at the United Nations Conference on Sustainable Development to become the Sustainable Development Goals (SDGs) with a target year of 2030. The SDGs are 17 goals that call for global collaboration to tackle a wide variety of recognized problems. Goal 3 is focused on ensuring health and well-being for women of all ages. A specific target is to achieve a global maternal mortality ratio of less than 70 per 100,000 live births. So far, specific progress has been made in births attended by a skilled provider, now at 80% of births worldwide compared with 62% in 2005.


title: Maternal death

text: Countries and local governments have taken political steps in reducing maternal deaths. Researchers at the Overseas Development Institute studied maternal health systems in four apparently similar countries: Rwanda, Malawi, Niger, and Uganda. In comparison to the other three countries, Rwanda has an excellent recent record of improving maternal death rates. Based on their investigation of these varying country case studies, the researchers conclude that improving maternal health depends on three key factors:


title: Maternal death

text: In terms of aid policy, proportionally, aid given to improve maternal mortality rates has shrunken as other public health issues, such as HIV/AIDS and malaria have become major international concerns. Maternal health aid contributions tend to be lumped together with newborn and child health, so it is difficult to assess how much aid is given directly to maternal health to help lower the rates of maternal mortality. Regardless, there has been progress in reducing maternal mortality rates internationally.


title: Maternal death

text: In countries where abortion practices are not considered legal, it is necessary to look at the access that women have to high-quality family planning services, since some of the restrictive policies around abortion could impede access to these services. These policies may also affect the proper collection of information for monitoring maternal health around the world.


title: Maternal death

text: Maternal deaths and disabilities are leading contributors in women's disease burden with an estimated 303,000 women killed each year in childbirth and pregnancy worldwide. The global rate in 2017 is 211 maternal deaths per 100,000 live births and 45% of postpartum deaths occur within 24 hours. Ninety-nine percent of maternal deaths occur in low-resource countries.


title: Maternal death

text: At a country level, India (19% or 56,000) and Nigeria (14% or 40,000) accounted for roughly one third of the maternal deaths in 2010. Democratic Republic of the Congo, Pakistan, Sudan, Indonesia, Ethiopia, United Republic of Tanzania, Bangladesh and Afghanistan accounted for between 3 and 5 percent of maternal deaths each. These ten countries combined accounted for 60% of all the maternal deaths in 2010 according to the United Nations Population Fund report. Countries with the lowest maternal deaths were Greece, Iceland, Poland, and Finland.


title: Maternal death

text: As of 2017, countries in Southeast Asia and Sub-Saharan Africa account for approximately 86% of all maternal death in the world. Sub-Saharan African countries accounted for about two-thirds of the global maternal deaths and Southeast Asian countries accounted for approximately one-fifth. Since 2000, Southeast Asian countries have seen a significant decrease in maternal mortality with an overall decrease in maternal mortality of almost 60%. Sub-Saharan Africa also saw an almost 40% decrease in maternal mortality between 2000 and 2017. As of 2017, the countries with the highest maternal mortality rates included South Sudan, Somalia, Central African Republic, Yemen, Syria, South Sudan, and the Democratic Republic of the Congo. The numbers for maternal mortality in these countries are likely affect by the political and civil unrest that these countries are facing.


title: Maternal death

text: Significant progress has been made since the United Nations made the reduction of maternal mortality part of the Millennium Development Goals (MDGs) in 2000. Bangladesh, for example, cut the number of deaths per live births by almost two-thirds from 1990 to 2015. A further reduction of maternal mortality is now part of the Agenda 2030 for sustainable development. The United Nations has more recently developed a list of goals termed the Sustainable Development Goals. The target of the third Sustainable Development Goal (SDG) is to reduce the global maternal mortality rate (MMR) to less than 70 per 100,000 live births by 2030. Some of the specific aims of the Sustainable Development Goals are to prevent unintended pregnancies by ensuring more women have access to contraceptives, as well as providing women who become pregnant with a safe environment for delivery with respectful and skilled care. This initiative also included access to emergency services for women who developed complications during delivery.


title: Maternal death

text: The WHO has developed a global goal to end preventable death related to maternal mortality. A major goal of this strategy is to identify and address the causes of maternal and reproductive morbidities and mortalities, as well as disabilities related to maternal health outcomes. Their strategy aims to address inequalities in access to reproductive, maternal, and newborn services, as well as the quality of care with universal health coverage. The WHO strategy also aims to ensure quality data collection in order to better respond to the needs of women and girls while improving the equity and quality of care provided to women.


title: Maternal death

text: There are significant maternal mortality intra-country variations, especially in nations with large equality gaps in income and education and high healthcare disparities. Women living in rural areas experience higher maternal mortality than women living in urban and sub-urban centers because those living in wealthier households, having higher education, or living in urban areas, have higher use of healthcare services than their poorer, less-educated, or rural counterparts. There are also racial and ethnic disparities in maternal health outcomes which increases maternal mortality in marginalized groups.


title: Maternal death

text: The maternal mortality ratio (MMR) is the annual number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes).


title: Maternal death

text: In the year 2017, 810 women died from preventable causes related to pregnancy and birth per day which totaled to approximately 295,000 maternal deaths that year alone. It was also estimated that 94% of maternal deaths occurred in low-resource countries in the same year.


title: Maternal death

text: In a retrospective study done across several countries in 2007, the cause of death and causal relationship to the mode of delivery in pregnant women was examined from the years 2000 to 2006. It was discovered that the excess maternal death rate of women who experienced a pulmonary embolism was casually related to undergoing a cesarean delivery. There was also an association found between neuraxial anesthesia, more commonly known as an epidural, and an increased risk for an epidural hematoma. Both of these risks could be reduced by the institution of graduated compression, whether by compression stockings or a compression device. There is also speculation that eliminating the concept of elective cesarean sections in the United States would significantly lower the maternal death rate.


title: Maternal death

text: Severe maternal morbidity (SMM) is an unanticipated acute or chronic health outcome after labor and delivery that detrimentally affects a woman's health. Severe Maternal Morbidity (SMM) includes any unexpected outcomes from labor or delivery that cause both short and long-term consequences to the mother's overall health. There are nineteen total indicators used by the CDC to help identify SMM, with the most prevalent indicator being a blood transfusion. Other indicators include an acute myocardial infarction ("heart attack"), aneurysm, and kidney failure. All of this identification is done by using ICD-10 codes, which are disease identification codes found in hospital discharge data. Using these definitions that rely on these codes should be used with careful consideration since some may miss some cases, have a low predictive value, or may be difficult for different facilities to operationalize. There are certain screening criteria that may be helpful and are recommended through the American College of Obstetricians and Gynecologists as well as the Society for Maternal-Fetal Medicine (SMFM). These screening criteria for SMM are for transfusions of four or more units of blood and admission of a pregnant woman or a postpartum woman to an ICU facility or unit.


title: Maternal death

text: The greatest proportion of women with SMM are those who require a blood transfusion during delivery, mostly due to excessive bleeding. Blood transfusions given during delivery due to excessive bleeding has increased the rate of mothers with SMM. The rate of SMM has increased almost 200% between 1993 (49.5 per 100,000 live births) and 2014 (144.0 per 100,000 live births). This can be seen with the increased rate of blood transfusions given during delivery, which increased from 1993 (24.5 per 100,000 live births) to 2014 (122.3 per 100,000 live births).


title: Maternal death

text: In the United States, severe maternal morbidity has increased over the last several years, impacting greater than 50,000 women in 2014 alone. There is no conclusive reason for this dramatic increase. It is thought that the overall state of health for pregnant women is impacting these rates. For example, complications can derive from underlying chronic medical conditions like diabetes, obesity, HIV/AIDS, and high blood pressure. These underlying conditions are also thought to lead to increased risk of maternal mortality.


title: Maternal death

text: The increased rate for SMM can also be indicative of potentially increased rates for maternal mortality, since without identification and treatment of SMM, these conditions would lead to increased maternal death rates. Therefore, diagnosis of SMM can be considered a "near miss" for maternal mortality. With this consideration, several different expert groups have urged obstetric hospitals to review SMM cases for opportunities that can lead to improved care, which in turn would lead to improvements with maternal health and a decrease in the number of maternal deaths.


title: Changa (drug)

text: Changa () is a blend of "N","N"-Dimethyltryptamine (DMT) mixed with a monoamine oxidase inhibitor (MAOI). The addition of MAOIs extend the DMT experience in duration and intensity when compared with smoking DMT freebase alone. Typically, extracts from DMT-containing plants are combined with a blend of different MAOI-containing herbs, such as the ayahuasca vine, and/or leaf or harmala alkaloids from "Peganum harmala" to create a mix that is 25 to 50% DMT.


title: Changa (drug)

text: Changa was created by Julian Palmer in 2003-2004 and named when he 'asked' for a moniker for the drug during an ayahuasca session. Palmer actively 'seeded' Changa throughout the world, introducing it to the UK, Russia, India, Morocco, West Africa, Chile, Montenegro and China.


title: Changa (drug)

text: The substance grew in popularity from the mid 2000s. Its international introduction dates to the Boom Festival in Portugal in 2008.


title: Changa (drug)

text: Changa's popularity has continued due to its ease of smoking, more powerful effects and longer duration (approximately 10-20 minutes) when compared to smoking freebase DMT crystal.


title: Changa (drug)

text: Any number of blend combinations are possible. Doses vary substantially from one sample to the next depending on what ingredients are used and in what ratio. Some Changa samples can be more than 100 times stronger than others.


title: Changa (drug)

text: Julian Palmer has written,"Changa has been commonly reported to consist of simply Banisteriopsis caapi leaf and DMT, and this recipe works very well... Any herb or plant can be used in changa, and many different herbs are being used by different people around the world in different ratios and blends. It should be kept in mind that the ayahuasca element activates the herbs used, and each new herb may not have the desired effect, or may have an unpredictable effect.


title: Changa (drug)

text: So, a ‘classic’ and ‘original’ changa blend that has stood the test of time looks something like this:


title: Changa (drug)

text: 30% ayahuasca vine and/or leaf 20% mullein 20% passionflower 20% peppermint 5% calendula 5% blue lotus"


title: Changa (drug)

text: Australian electronic trio Pnau titled their November 2017 album Changa in homage to the substance. It reached a peak of number 11 on the ARIA charts.


title: Consolidated B-32 Dominator

text: The Consolidated B-32 Dominator (Consolidated Model 34) was an American heavy strategic bomber built for United States Army Air Forces during World War II, which had the distinction of being the last Allied aircraft to be engaged in combat during World War II; that engagement also resulted in the last American to die in air combat in World War II. It was developed by Consolidated Aircraft in parallel with the Boeing B-29 Superfortress as a fallback design should the B-29 prove unsuccessful. The B-32 only reached units in the Pacific in mid-May 1945, and subsequently saw only limited combat operations against Japanese targets before the formal end of the war on 2 September 1945. Most of the extant orders of the B-32 were canceled shortly thereafter and only 118 B-32 airframes of all types were built.


title: Consolidated B-32 Dominator

text: The engineering development of the B-29 had been underway since mid-1938 when, in June 1940, the United States Army Air Corps requested a similar design from the Consolidated Aircraft Company in case of development difficulties with the B-29.


title: Consolidated B-32 Dominator

text: The Model 33 on which Consolidated based its proposal was similar to the B-24 Liberator. Like the B-24 it was originally designed with a twin tail and a large Davis wing, but with a longer, rounder fuselage and a rounded nose. The powerplants were to be the same quartet of eighteen-cylinder, Wright Duplex-Cyclones, as specified for B-29s. The aircraft was designed to be pressurized, and have remote-controlled retractable gun turrets with fourteen machine guns. It was to have an estimated gross weight of . The first contract for two XB-32s was signed on 6 September 1940, the same day as the contract for the Boeing prototype XB-29.


title: Consolidated B-32 Dominator

text: The first XB-32-CO, AAF s/n 41-141, was constructed next to the Army Air Forces (AAF) Base Tarrant Field Airdrome at the AAF Aircraft Plant No. 4 just west of Fort Worth, Texas along the south side of Lake Worth. The Consolidated Vultee Bomber Plant assembly line was six months behind schedule, the aircraft making its first flight on 7 September 1942. Due to problems with the pressurization system, the gun turrets and landing gear doors, these items were omitted on the first prototype. The aircraft had R-3350-13 engines inboard and R-3350-21s outboard, with all four powerplants driving three-bladed propellers. The XB-32 had persistent problems with engine oil leaks and poor cooling, but the B-29 also had similar engine problems. The inboard propellers' pitch could be reversed to shorten the landing roll or to roll back in ground maneuvers.


title: Consolidated B-32 Dominator

text: The first XB-32 was armed with eight machine guns in dorsal and ventral turrets, and an odd combination of two .50 caliber and one cannon in each outboard engine nacelle firing rearwards, plus two .50 caliber machine guns in the wings outboard of the propellers. The turrets were remotely controlled from periscopic sights in aiming stations inside the aircraft. The sights were coordinated by a sophisticated analog computer system developed by Sperry Gyroscope Company.


title: Consolidated B-32 Dominator

text: On 17 March 1943, the initial contract was signed for 300 B-32-CFs but development problems continued. On 10 May 1943, the first XB-32 crashed on takeoff after making a total of 30 flights before the second XB-32, s/n 41-142, finally flew on 2 July 1943. This aircraft had a traditional stepped cockpit canopy. Upon examination and testing, the USAAF recommended a large number of changes that included more conventional gun stations.


title: Consolidated B-32 Dominator

text: The pressurization system had problems which were never solved and so the role of the aircraft was changed to operating at low to medium altitude. This decision meant that the pressurization system was easily eliminated from production aircraft. Problems with the remote-controlled gun turrets were never solved and the armament on production aircraft was changed to 10 .50 caliber machine guns in manually operated turrets: Sperry A-17 turrets in the nose and tail, two Martin A-3F-A dorsal turrets, and one Sperry A-13-A ball turret. The bomb load was increased by to .


title: Consolidated B-32 Dominator

text: The second XB-32 continued to have stability problems. In an attempt to resolve this a B-29 style tail was fitted to the aircraft after its 25th flight but this did not resolve the problem and a Consolidated-designed vertical tail was added and first flown on the third XB-32, s/n 41-18336 on 3 November 1943. The first production aircraft was fitted with a B-29 vertical tail until the new Consolidated tail was available for installation.


title: Consolidated B-32 Dominator

text: By 1944 testing of the three prototypes permitted the AAF to place orders for over 1,500 B-32s. The first production aircraft was delivered on 19 September 1944, by which time the B-29 was in combat in China. The first B-32 crashed on the same day it was delivered when the nose wheel collapsed on landing. Beginning on 27 January 1945, 40 B-32A-5, -10 and -15 aircraft were delivered as unarmed TB-32-CF crew trainers.


title: Consolidated B-32 Dominator

text: Originally, the Army Air Forces intended the B-32 as a "fallback" design to be used only if the B-29 program fell significantly behind in its development schedule. As development of the B-32 became seriously delayed this plan became unnecessary due to the success of the B-29. Initial plans to use the B-32 to supplement the B-29 in re-equipping B-17 and B-24 groups before redeployment of the Eighth and Fifteenth Air Forces to the Pacific were stymied when only five production models had been delivered by the end of 1944, by which time B-29 operations were underway in the Twentieth Air Force.


title: Consolidated B-32 Dominator

text: The first assignment of the B-32 began when General George Kenney, the commander of Allied air forces in the South West Pacific Area and commander of the U.S. Fifth Air Force, traveled to Washington D.C. to request B-29s. Since priority had been given to strategic bombing by the B-29, Kenney's request was denied, after which he then requested the B-32.


title: Consolidated B-32 Dominator

text: Following a demonstration, the Army General Staff agreed that Kenney could conduct a combat evaluation, and a test schedule of 11 missions was set up, followed by a plan to re-equip two of the 312th Bomb Group's four Douglas A-20 Havoc squadrons with the B-32. Project crews took three B-32s to Clark Field, Luzon, Philippine Islands, in mid-May 1945 for a series of test flights completed on 17 June.


title: Consolidated B-32 Dominator

text: The three test B-32s were assigned to the 312th BG's 386th Bombardment Squadron. On 29 May 1945, the first of four combat missions by the B-32 was flown against a supply depot at Antatet in the Philippines, followed by two B-32s dropping 16 bombs on a sugar mill at Taito, Formosa, on 15 June. On 22 June, a B-32 bombed an alcohol plant at Heito, Formosa, with bombs, but a second B-32 missed flak positions with its fragmentation bombs. The last mission was flown on 25 June against bridges near Kiirun on Formosa.


title: Consolidated B-32 Dominator

text: The test crews were impressed with its unique reversible-pitch inboard propellers and the Davis wing, which gave it excellent landing performance. However, they found a number of faults: the cockpit was noisy and had a poor instrument layout, the bombardier's vision was limited, the aircraft was overweight, and the nacelle design resulted in frequent engine fires (a deficiency shared with the B-29 Superfortress). However, the testing missions were mostly successful.


title: Consolidated B-32 Dominator

text: In July 1945, the 386th Bomb Squadron completed its transition to the B-32, flying six more combat missions before the war ended. On 13 August, the 386th BS moved from Luzon to Yontan Airfield on Okinawa and flew mostly photographic reconnaissance missions. On 15 August, Japan surrendered (documents signed 2 September), and the 386th's missions were intended to monitor Japan's compliance with the ceasefire and to gather information such as possible routes occupation forces could take into Tokyo. On 17 August, the B-32s were intercepted by Japanese fighters. During the two-hour engagement, the Dominators suffered only minor damage and none of their crew were injured. "Though the B-32 gunners later claimed to have damaged one fighter and 'probably destroyed' two others, surviving Japanese records list no losses for that day or next." Based on the Japanese action on the 17 August, U.S. commanders felt that it was important to continue the reconnaissance missions over Tokyo so they could determine if it was an isolated incident or an indication that Japan would reject the ceasefire and continue fighting.


title: Consolidated B-32 Dominator

text: On 18 August 1945, four Dominators were given the task of photographing many of the targets covered on the previous day; however, mechanical problems caused two to be pulled from the flight. Over Japan, a formation of 14 A6M Zeros and three N1K2-J Shiden-Kai (George) fighters (apparently mis-identified as Ki-44 Tojos by the American crews) attacked the remaining two U.S. aircraft. Saburō Sakai, a Japanese ace, said later that there was concern that the Dominators were attacking. Another Japanese ace, Sadamu Komachi, stated in a 1978 Japanese magazine article that the fighter pilots could not bear to see American bombers flying serenely over a devastated Tokyo.


title: Consolidated B-32 Dominator

text: The B-32 Dominator "Hobo Queen II" (s/n 42-108532) was flying at when the Japanese fighters took off and received no significant damage. "Hobo Queen II" claimed two Zeros destroyed in the action as well as a probable Shiden-Kai. Japanese records show that no aircraft were lost. The other Dominator was flying below "Hobo Queen II" when the fighters took off. The fighters heavily damaged that Dominator, initially wounding the dorsal gunner and then seriously wounding two other members. Photographer Staff Sergeant Joseph Lacharite was wounded in the legs (his recovery required several years). Sergeant Anthony Marchione, a photographer's assistant, helped Lacharite and then was fatally wounded himself. Marchione was the last American to die in air combat in World War II. Despite the damage, the Dominator returned to Okinawa. However, the incident precipitated the removal of propellers from all Japanese fighters as per the terms of the ceasefire agreement, beginning 19 August 1945. The last B-32 combat photo reconnaissance mission was completed on 28 August, during which two B-32s were destroyed in separate accidents, with 15 of the 26 crewmen killed. On 30 August, the 386th Bomb Squadron stood down from operations.


title: Consolidated B-32 Dominator

text: Production contracts of the B-32 were cancelled on 8 September 1945, with production ceased by 12 October. Many B-32s ended up being salvaged at Walnut Ridge, Arkansas with a total of 38 flown to Kingman Army Airfield for disposal. Along with several other noteworthy aircraft on temporary display at Davis Monthan AFB after World War II, the last surviving Dominator, B-32-1-CF #42-108474, was written off and destroyed in 1949.


title: Consolidated B-32 Dominator

text: A total of 300 B-32s ordered, 118 delivered, 130 flyable, 170 cancelled, orders for a further 1,099 B-32-CFs and 499 B-32-COs were cancelled after VJ-Day.


title: Consolidated B-32 Dominator

text: No examples of a B-32 remain today. The XB-32 (AAF Ser. No. 41-18336) was used as a ground instructional airframe for fire fighting training. Others were written off after suffering major damage in operational accidents. Excess inventories were flown either to Walnut Ridge Army Airfield, Arkansas, to be scrapped by the Texas Railway Equipment Company, or to Kingman Army Airfield, Arizona to be scrapped by the Wunderlich Construction Company.


title: Consolidated B-32 Dominator

text: One of the few portions of a B-32 surviving is a wing panel removed from a static test model and erected at the Montgomery Memorial near San Diego, California as a monument to aviation pioneer John J. Montgomery.


title: Consolidated B-32 Dominator

text: Several Sperry A-17 nose/tail turrets, unique to the B-32, survive in various U.S. locations. These included the National Air and Space Museum, the National Museum of the U.S. Air Force, the Commemorative Air Force, the National Warplane Museum in Geneseo, New York and at least four others in private collections.


title: Liberalism (international relations)

text: Liberalism is a school of thought within international relations theory which revolves around three interrelated principles:


title: Liberalism (international relations)

text: This school of thought emphasizes three factors that encourage more cooperation and less conflict among states:


title: Liberalism (international relations)

text: Liberals believe that international institutions play a key role in cooperation among states via interdependence. There are three main components of interdependence. States interact in various ways, through economic, financial, and cultural means; security tends to not be the primary goal in state-to-state interactions; and military forces are not typically used. Liberals also argue that international diplomacy can be a very effective way to get states to interact with each other honestly and support nonviolent solutions to problems. With the proper institutions and diplomacy, Liberals believe that states can work together to maximize prosperity and minimize conflict.


title: Liberalism (international relations)

text: Liberalism is one of the main schools of international relations theory. Liberalism comes from the Latin "liber" meaning "free", referring originally to the philosophy of freedom. Its roots lie in the broader liberal thought originating in the Enlightenment. The central issues that it seeks to address are the problems of achieving lasting peace and cooperation in international relations, and the various methods that could contribute to their achievement.


title: Liberalism (international relations)

text: Liberalism originally arose from both deep scholarly and philosophical roots. With the theory's prime principle being international cooperation and peace, early influences are seen in some bigger religious practices sharing the same goal. It was later in the 17th and 18th centuries in which political liberalism began to take a form that challenged nobility and inherited inequality. Followed shortly after was the Enlightenment where liberal ideals began to develop with works by philosophers such as Voltaire, Locke, Smith, and German thinker Immanuel Kant. In part, liberal scholars were influenced by the Thirty Years' War and the Enlightenment. The length and disastrous effects of the Thirty Years' War caused a common disdain for warfare throughout much of Europe. Thinkers, like Locke and Kant, wrote about what they saw in the world around them. They believed that war is fundamentally unpopular and that man is born with certain rights because the end of the Thirty Years' War proved these ideas to them.


title: Liberalism (international relations)

text: John Locke discusses many ideas that are now attributed to Liberalism in "Two Treatises of Government", published in 1689. In his second treatise, Locke comments on society and outlines the importance of natural rights and laws. Locke believes that people are born as blank slates without any preordained ideas or notions. This state is known as the State of Nature because it shows people in their most barbaric form. As people grow, their experiences begin to shape their thoughts and actions. They are naturally in the State of Nature until they choose not to be, until something changes their barbaric nature. Locke says that, civil government can remedy this anarchy. When it comes to the Law of Nature, people are more likely to act rationally when there is a government in place because there are laws and consequences to abide by. Locke argues that civil government can help people gain the basic human rights of health, liberty and possession. Governments that grant these rights and enforce laws benefit the world. Many of these ideas have influenced leaders such as the Founding Fathers during the American Revolution and French revolutionaries during the French Revolution.


title: Liberalism (international relations)

text: In Kant's "To Perpetual Peace", the philosopher set the way by forming guidelines to create a peace program to be applied by nations. This program would require cooperation between states as well as the mutual pursuit of secure freedom and shared benefits. One such idea was the Democratic Peace Theory. In "To Perpetual Peace", Kant put forth the idea that democracies do not fight wars because leaders were too worried about re-election. Because war was naturally unpopular, Kant thought that leaders would avoid burdening voters with its costs. After seeing success in intertwining states through economic coalition, liberal supporters began to believe that warfare was not always an inevitable part of international relations. Support of liberal political theory continued to grow from there.


title: Liberalism (international relations)

text: Kant's democratic peace theory has since been revised by neoliberals like Robert O. Keohane and Joseph S. Nye. These theorists have seen that democracies do in fact fight wars. However, democracies do not fight wars with other democracies because of capitalist ties. Democracies are economically dependent and therefore are more likely to resolve issues diplomatically. Furthermore, citizens in democracies are less likely to think of citizens in other democracies as enemies because of shared morals. Kant's original ideas have influenced liberalist scholars and have had a large impact on liberal thought.


title: Mickey Haller

text: J. Michael "Mickey" Haller, Junior is a fictional character created by Michael Connelly in the 2005 novel "The Lincoln Lawyer". Haller, a Los Angeles-based defense attorney, is the paternal half-brother of Connelly's best-known character, LAPD Detective Hieronymus "Harry" Bosch. The Mickey Haller series consists of six published novels, with the most recent published in 2020.


title: Mickey Haller

text: A film adaptation of "The Lincoln Lawyer", starring Matthew McConaughey as Mickey Haller, was released in the spring of 2011.


title: Mickey Haller

text: A television series adaptation of "The Lincoln Lawyer" from David E. Kelley and A+E Studios, is now streaming on Netflix. Mexican actor Manuel Garcia-Rulfo stars as Mickey Haller, as the series explores the character's Latino heritage.


title: Mickey Haller

text: Haller is significantly younger than his half-brother, Bosch. When Bosch first met his father, Michael Haller Sr., Bosch was an adult but Mickey was only five years old. (However, in chapter 19 of "The Black Ice", Bosch mentions just one, unnamed half-brother. Bosch notes that the half-brother is a defense attorney and “probably born a few years ahead of Bosch”.) The elder Michael Haller was one of Los Angeles' premier criminal defense attorneys and his clients included mobster Mickey Cohen and one of the Manson girls. He was born from his father's second marriage. He was born five months after his parents wed and they wed less than two months after his father divorced his first wife. Haller's mother was much younger than his father and came from Mexico where she was a famous actress, and in "The Fifth Witness", Haller himself says that he looks "more south of the border than north". Little is known of Haller's childhood other than the death of his father (which occurred shortly after the meeting with Bosch) and his inheritance of his father's Colt Woodsman pistol, mentioned in "The Lincoln Lawyer". Haller followed in his father's footsteps, becoming a defense attorney. Most of Haller's knowledge of his father comes from law books he has read and stories from judges and other lawyers who had worked with the elder Haller prior to his death.


title: Mickey Haller

text: The Mickey Haller novels are narrated almost exclusively in the first-person by Mickey Haller. As such, "The Crossing" – although it features appearances by Mickey Haller – is a Harry Bosch novel because it is narrated entirely in the third person. By comparison, all but two of the Harry Bosch novels are narrated in the third-person. (Both "Lost Light" and "The Narrows" are narrated in the first person by the temporarily retired Harry Bosch.) The second novel featuring Mickey Haller, "The Reversal," could be considered a crossover novel, as it contains both Harry Bosch-centered chapters, narrated in the third person (including third-person scenes featuring Mickey Haller) and Mickey Haller-centered chapters, narrated in the first person.


title: Mickey Haller

text: As it stands, there are six novels in The Lincoln Lawyer series. The latest is "The Law of Innocence", which is narrated from Haller's point of view.


title: Mickey Haller

text: Haller has been married and divorced twice, once to Maggie McPherson and once to Lorna Taylor. McPherson, with whom he has a daughter, Hayley, is a career prosecutor with the Los Angeles County District Attorney's Office, and is nicknamed "McFierce" by defense lawyers. They divorced due to their opposite careers—Haller was defending accused criminals, while McPherson was prosecuting them. They have continued to maintain a close relationship, with periodic reconciliations. Taylor is currently Haller's Case Manager and is married to Haller's current investigator, Dennis "Cisco" Wojciechowski. Haller maintains good relationships with both of his ex-wives and has joint custody of his daughter. In "The Brass Verdict", Haller is revealed to have visitation of his daughter on Wednesday nights and alternate weekends. By the events of "The Fifth Witness," however, Haller reveals that is only the "official arrangement" and he sees his daughter far more frequently.


title: Mickey Haller

text: During the series Haller has used two private investigators for his trials. The first, Raul "Mish" Levin was murdered during the events of "The Lincoln Lawyer", his nickname "Mish" was bestowed upon him by Haller after Haller learned of his "mish-mash" of Mexican-Jewish ancestry. His second investigator, Wojciechowski, was formerly a member of the motorcycle gang The Road Saints, whom Haller frequently represented, and was nicknamed by the gang after the Cisco Kid, an outlaw-adventurer Wild West character created by O. Henry in 1907. Cisco was introduced in "The Brass Verdict".


title: Mickey Haller

text: Haller was nicknamed "the Lincoln Lawyer" because of his preference for working out of his Lincoln Town Car instead of in an office. However, during "The Fifth Witness", Haller temporarily rents an office on a one-year lease. With the influx in foreclosure clients at that time, Haller has hired an associate, Jennifer "Bullocks" Aronson, a new graduate of Southwestern Law School, which is located in the former Bullocks Wilshire.


title: Mickey Haller

text: In "9 Dragons", Haller makes a short cameo as Harry Bosch's lawyer; a murder suspect even states that Matthew McConaughey was his alibi. He later suggests that their daughters (Harry's Maddie and Mickey's Hayley) should get together; their daughters would later meet during the events of "The Reversal." Later on in the book, a reference is made to the movie adaptation of "The Lincoln Lawyer" starring Matthew McConaughey.


title: Mickey Haller

text: Haller's discomfort with representing the guilty is a constant theme in the series, and he has twice attempted to move to the prosecution side. In "The Reversal", Haller is appointed as a special prosecutor to overturn the exoneration of Jason Jessup, a convicted child-murderer who was freed after DNA evidence cleared him of wrongdoing. Haller teams up with McPherson and Bosch to retry Jessup. At the end of "The Fifth Witness", Haller files to run for Los Angeles County district attorney, with McPherson's support. At the beginning of "The Gods of Guilt", however, it is described that his campaign turned into disaster when the client whom he got acquitted for drunk driving does the same thing again, killing a mother and her daughter, the latter being a classmate of Haller's daughter who then refuses to talk to him for most of the book.


title: Anthony Geary

text: Anthony Geary (born May 29, 1947) is an American actor. He is known for playing the role of Luke Spencer on the ABC daytime drama "General Hospital". He originated the role of Luke in 1978 and received a record eight Daytime Emmy Awards for Outstanding Lead Actor in a Drama Series prior to his retirement. Geary had a prominent supporting role in the "Weird Al" Yankovic comedy "UHF" (1989); other notable films include "Johnny Got His Gun" (1971), "Disorderlies" (1987), "Scorchers" (1991), "Teacher's Pet" (2004) and "Fish Tank" (2009).