President Vladimir Putin signed a law on Friday that bans Americans from adopting Russian children and imposes other measures in retaliation for new U.S. legislation meant to punish Russian human rights abusers.

The law, which has ignited outrage among Russian liberals and children's rights advocates, enters into force on Jan. 1 and is likely to strain U.S.-Russia relations.

As well as banning U.S. adoptions, it will also outlaw some non-governmental organizations that receive U.S. funding and impose a visa ban and asset freeze on Americans accused of violating the rights of Russians abroad.

The law could block dozens of Russian children expected to be adopted by American families from leaving the country and cut off one of the main international routes for Russian children to leave orphanages that are often dismal. Russia is the single biggest source of adopted children in the United States, with more than 60,000 Russian children being taken in by Americans over the past two decades.

The bill is retaliation for an American law that calls for sanctions against Russians deemed to be human rights violators and part of an increasingly confrontational stance by the Kremlin against the West.

Related: Americans may lose right to adopt Russian children

Putin said U.S. authorities routinely let Americans suspected of violence toward Russian adoptees go unpunished — a clear reference to Dima Yakovlev, a Russian toddler for whom the bill is named. The child was adopted by Americans and then died in 2008 after his father left him in a car in broiling heat for hours. The father was found not guilty of involuntary manslaughter.

Children's rights ombudsman Pavel Astakhov on Wednesday said that 46 children who were about to be adopted in the United States would remain in Russia if the bill came into effect. On Thursday, he petitioned the president to extend the ban to other countries.

Courtesy Thomas family

John and Renee Thomas with their son, Jack, 7, who was adopted from Russia at the age of 3. Jack is hoping for his brother, Nikoly, now in a Russian orphanage, to join him in the United States.

Would-be adoptive parents in the United States are left hanging by Putin's signing of the bill, which was passed by Russian lawmakers last week.

Among them are John and Renee Thomas of Minnetonka, Minn., Kari Huus of NBC News reported. The Thomases have already adopted Jack, 7, from Russia. When they found out he had a little brother, they began the process to try to adopt him, too. The wait has stretched to four years, and now the adoption may be in danger. 

"When Jack is asked about his family, he talks about his brother," John Thomas said. "He always asks, 'When is he coming home?' We just tell him we’re waiting for the call."

More: Adoption of little brother caught in US-Russia spat

UNICEF estimates that there are about 740,000 children without parental custody in Russia, while only 18,000 Russians are now waiting to adopt a child.

The U.S. State Department on Thursday repeated its opposition to the Russian measure.

"The welfare of children is simply too important to tie to the political aspects of our relationship," State Department spokesman Patrick Ventrell said. "Additionally, we are deeply troubled by the provisions in the bill that would restrict the ability of Russian civil society organizations to work with American partners."  

Critics of the bill left dozens of stuffed toys and candles outside the parliament's lower and upper houses to express solidarity with Russian orphans. 

An online petition urging the Kremlin to scrap the bill garnered more than 100,000 Russian signatures. 

The Associated Press contributed to this report.

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Miraflores Press via EPA

Hugo Chavez, left, and Venezuelan Vice President Nicolas Maduro talk during a national broadcast in Caracas, Venezuela on Saturday. Chavez said that he will return to Cuba to undergo further cancer surgery. He also said that if his health was to deteriorate and new elections were to be held, his supporters should vote for Maduro.

CARACAS, Venezuela - President Hugo Chavez said on Saturday he would undergo another cancer operation after doctors in Cuba found a third recurrence of malignant cells in his pelvic area.

The news is a big blow for his supporters in South America's biggest oil exporter, who elected him in October to a new six-year term in power. Chavez has twice said he was cured, and then had to return to Cuba for more surgery.

In a televised broadcast flanked by ministers at the Miraflores presidential palace, Chavez said that if anything happened to him and a new vote had to be held, his supporters should vote for Vice President Nicolas Maduro - the first time the socialist leader has named a successor.

Chavez returned to Venezuela on Friday from having medical treatment in Cuba, ending a three-week absence from public view.

"Unfortunately, during these exhaustive exams they found some malignant cells in the same area ... . It is absolutely necessary, absolutely essential, that I have to undergo a new surgical intervention," the 58-year-old said, looking resolute.

"With God's will, like on the previous occasions, we will come out of this victorious."

The president has already had three cancer operations in Cuba since the middle of last year. News of more surgery will likely raise new doubts about his future and the fate of his self-styled "revolution" in the OPEC nation.
Chavez, who has dominated Venezuelan politics since taking power 14 years ago, said he would return to Havana on Sunday.

Under Venezuela's constitution, an election would have to be held within 30 days if Chavez were to leave office within the first four years of his next term, due to begin on Jan. 10.

The president has been receiving treatment at the Cimeq hospital in Havana as a guest of his friend and political mentor, former Cuban leader Fidel Castro.

Slideshow: Hugo Chavez through the years

/

The life of Venezuelan president Hugo Chavez from his rise as a lieutenant colonel after his failed coup attempt in 1992.

Launch slideshow

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Updated at 12:21 a.m. ET: A debate over abortion has flared in Ireland over the case of Savita Halappanavar, a miscarrying woman suffering from blood poisoning who was refused a quick termination of her pregnancy and died in a hospital.

AFP - Getty Images

This handout picture received from the Irish Times on November 14, 2012 shows Indian national Savita Halappanavar who died after being refused a termination of her pregnancy at a hospital in Galway.

The 31-year-old's case highlights a bizarre legal trap in which pregnant women facing severe health problems in predominantly Catholic Ireland may find themselves.

It also prompted widespread anger, including protests in Dublin outside Ireland’s parliament, the Dáil Éireann. About 400 people gathered for a candelit vigil for Halappanavar in Cork, in the south of Ireland, the Irish Times reported.

Ireland's constitution officially bans abortion, but a 1992 Supreme Court ruling found it should be legalized for situations when the woman's life is at risk from continuing the pregnancy. Five governments since have refused to pass a law resolving the confusion, leaving Irish hospitals reluctant to terminate pregnancies except in the most obviously life-threatening circumstances.

Opposition politicians appealed Wednesday for Prime Minister Enda Kenny's government to introduce legislation immediately to make the 1992 Supreme Court judgment part of statutory law. Barring any such bill, the only legislation defining the illegality of abortion in Ireland dates to 1861 when the entire island was part of the United Kingdom. That British law, still valid here due to Irish inaction on the matter, states it is a crime to "procure a miscarriage."

Halappanavar, an Indian dentist living in Galway since 2008, was 17 weeks along in her pregnancy when she was admitted to the hospital.

University Hospital Galway in western Ireland declined to say whether doctors believed Halappanavar's blood poisoning could have been reversed had she received an abortion rather than wait for the fetus to die on its own. In a statement it described its own investigation into the death, and a parallel probe by the national government's Health Service Executive, as "standard practice" whenever a pregnant woman dies in a hospital. The Galway coroner also planned a public inquest.

Halappanavar's husband, Praveen, said doctors determined that she was miscarrying within hours of her hospitalization for severe pain on Sunday, Oct. 21. He said that over the next three days doctors refused their requests for a termination of her fetus to combat her own surging pain and fading health.

"Savita was really in agony. She was very upset, but she accepted she was losing the baby," her husband told The Irish Times in a telephone interview from Belgaum, southwest India. "When the consultant came on the ward rounds on Monday morning, Savita asked: 'If they could not save the baby, could they induce to end the pregnancy?' The consultant said: 'As long as there is a fetal heartbeat, we can't do anything.'"

"Again on Tuesday morning ... the consultant said it was the law, that this is a Catholic country. Savita said: "I am neither Irish nor Catholic," but they said there was nothing they could do," Praveen Halappanavar was quoted as saying.

He said his wife vomited repeatedly and collapsed in a restroom that night, but doctors wouldn't terminate the fetus because its heart was still beating.

The fetus died the following day and its remains were surgically removed. Within hours, Praveen Halappanavar said, his wife was placed under sedation in intensive care with systemic blood poisoning and he was never able to speak with her again. By Saturday, her heart, kidneys and liver had stopped working and she was pronounced dead early Sunday, Oct. 28.

Praveen Halappanavar said he took his wife's remains back to India for a Hindu funeral and cremation on Nov. 3. News of the circumstances that led to her death emerged Tuesday in Galway after the Indian community canceled the city's annual Diwali festival. Savita had been one of the festival's organizers.

 At the vigil in Cork, child psychologist Mary Phelan told The Irish Times that she was furious about what had happened.

"I couldn't find the words to describe how I felt, I was so outraged when I heard what happened to this poor woman," Phelan said. "I feel mortified in front of the world that we have stood by and allowed this happen in our country today. I think we should all be hanging our heads in shame."

Ivana Bacik, a pro-choice advocate and law professor at Trinity College in Dublin, echoed what many others on Wednesday: "I think there's a clear indication that governments' failure to legislate over a period of years is largely responsible for the uncertainty around the law," she told the Guardian.

Bacik was successfully prosecuted in the 1990s for “providing information” about abortions in England, according to the Guardian. She was nearly sent to jail.

History of birth control in Ireland
Until recently, Ireland’s social and professional worlds were hugely enmeshed with the Catholic church. In the 1980s, teachers applying for a job had to submit their priest as a reference, and it wasn’t until 1979 that condoms were legal – and then only by prescription, according to Irish Family Planning Association, the country’s leading sexual health charity.  

It wasn’t until 1993 that condoms could be purchased in vending machines.

Abortion has been mostly ignored in the political sphere – largely because women may leave the country for the procedure. In 2011, more than 4,000 women traveled to England; about 1,500 went to the Netherlands between 2005 and 2009. Other estimates say about 7,000 women leave the Ireland every year to terminate a pregnancy.

But even traveling has been difficult. In 2007, a pregnant 17-year-old dubbed “Miss D” said she wanted an abortion after learning that her fetus had anencephaly, according to irishhealth.com. That meant the baby’s brain would not fully develop and that the baby would most likely die in utero or within hours or days of its birth.   

A social worker told Miss D she couldn’t travel to England, and that police would ban her physically if necessary. Miss D sued and was ultimately able to leave the country.

NBC's Isolde Raftery and The Associated Press contributed to this report.

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CHICHIGALPA, Nicaragua – You won’t see a road sign pointing to “La Isla de Viudas,” or “The Island of Widows,” as it’s not the community’s official name. It’s a nickname born from a horrific body count. 

In the past 10 years, it’s believed that hundreds, if not thousands, of residents of Chichigalpa — mostly male sugarcane workers — have died from chronic kidney disease, or CKD. That in a city of nearly 60,000, roughly the size of Ames, Iowa. 

The mysterious and hidden epidemic, first highlighted by the Center for Public Integrity, has claimed thousands more lives across Central America. In El Salvador and Nicaragua alone, the number of men dying from the excruciatingly painful disease has risen five-fold in the last two decades. High rates of CKD also have been found in rural villages in India and among the rice paddies of Sri Lanka.

Sacorro Mendez Flores, who lives in the “La Isla” district of Chichigalpa, remembers when her son first fell ill. Jorge Luis Silva didn’t look sick at first, but inside he was dying. His kidneys struggled to filter waste from his body, to no avail. Five months ago, Flores buried him. 

“The same thing happened to my husband,” she said. “They both died the same.”

Sacorro Mendez-Flores, surrounded by her grandchildren, holds a family photo. The resident of Chichigalpa, Nicaragua, lost both her son and husband to chronic kidney disease.

Researchers are searching for answers about why this disease is ravaging not only the bodies of its victims, but the communities they leave behind. 

The illness spreads
More than 20 million Americans aged 20 and older have chronic kidney disease, according to the Centers for Disease Control and Prevention. In developed countries like the U.S., CKD often goes hand in hand with obesity, diabetes and hypertension. With treatment, including dialysis and kidney transplants, many with the disease survive. 

The CKD plaguing parts of Central America, however, is something scientists have never seen before.

“It affects people who don't have diabetes or hypertension, which are the usual risk factors for chronic kidney disease,” said Sasha Chavkin, a CPI reporter who has covered the mysterious epidemic for several years. “No one can figure out what it is that's making all these people sick.”

Slideshow: Mysterious malady fells sugarcane workers

Estbean Felix / AP

Workers in Central American sugarcane fields are dying of chronic kidney disease at an astonishing rate and experts are unable to say why.

Launch slideshow

“It comes at great social, economic and humanitarian cost,” said Dr. Daniel R. Brooks, an associate professor of epidemiology at the Boston University School of Health who is leading a research team looking for the cause of the epidemic. “These are working-age people who are being struck down, and whole communities are really hurt and devastated by this disease.” 

And with little or no access to the life-saving treatments available in the developed world, a CKD diagnosis is often tantamount to a death sentence. 

Related stories

In Nicaraguan sugarcane community, workers stare death in the face

Chronic kidney disease: 'Silent killer' may have multiple triggers

“Where we stand right now is that ultimately this disease is not treatable in this community,” said Nate Raines, a researcher with the Mt. Sinai School of Medicine Global Health program, which is collaborating with two organizations in Nicaragua on research independent from the Boston University group. “What we need to do is find the cause. That's the only way to really help the health situation.” 

Many in Chichigalpa believe that the root of the disease lies in chemicals sprayed in the sugarcane fields while men are working, or seeping into the water supply. A spokesperson from the sugar industry says the chemicals used are standard fertilizer and are not used to excess.  

Science, so far, points to a more complicated answer. 

'Markers' of kidney damage found
The research team from the Boston University has linked the disease in Central America to strenuous labor, dehydration and environmental conditions in which chemicals may play a role. That theory was supported by the group’s most recent study, which found “markers” of kidney damage in adolescents as young as 12 in affected communities. 

Thousands of miles away, research in Sri Lanka’s affected communities also indicates chemicals may play a key role in the illness devastating communities there.

As reported last month by the Center for Public Integrity, the country’s health ministry and World Health Organization announced in June that a years-long study had identified chemicals thought to be an essential cause of the disease: cadmium and arsenic. Both are heavy metals found in fertilizers and pesticides that can cause an array of health effects, including the type of kidney damage ravaging communities in Sri Lanka and Nicaragua.

While most of those tested had lower levels of the toxic elements than officially designated as dangerous by the United Nations, researchers believe that long-term exposure, likely through the food chain, may explain the high incidence of CDK. 

The findings, due to be officially released in October, represent a potential breakthrough in the research about CDK worldwide, including the epidemic in Nicaragua. 

Researchers in Central America have not pinpointed a chemical cause. But the new research on adolescents indicates the kidneys of those going into the fields may already be damaged, making the long days and repeated dehydration in the fields potentially deadly. 

Some experts also suggest that sugarcane workers may also unwittingly be harming themselves as they struggle to stay hydrated while cutting up to 11 tons of cane a day by hand.

For a refreshing pick-me-up, they occasionally slice a stalk of cane, peeling back its “bark” and sticking it in their mouths, where it produces a sweet sugary liquid. 

But investigators now wonder: Could that constant flow of sucrose, combined with 90-plus degree temperatures and severe daily dehydration, be a deadly cocktail that slowly brings on CKD? 

“We believe high amounts of sugar solutions may not cause much kidney damage,” said Dr. Richard Johnson, head of the division of renal disease and hypertension at the University of Colorado, Denver. “But under certain circumstances, such as dehydration, we’re concerned the sugar may actually be toxic in causing damage to the kidneys.”

The sugar link
Whether or not sugar consumption plays a direct role in causing the Central American form of CKD, activists say it is a thread that connects the disease to its northern cousin.

In the U.S., rampant sugar consumption – Americans eat an average of 22.2 teaspoons of sugar per day according to the American Heart Association—drives many of the diseases linked to CKD, including diabetes and hypertension. 

And with recent steep increases in the price and demand for sugar, more people are working longer hours in the sugarcane fields of Central America. In 2011, the U.S. imported 330,000 metric tons of raw sugar from Central America, or nearly one-quarter of total raw sugar imports that year, according to the United States Department of Agriculture.

“Not only is the production of sugar killing people, but the consumption of it is killing people,” said Jason Glaser of La Isla Foundation, a nonprofit group he founded to focus attention on the epidemic and fund research that he hopes will solve the mystery. “It's bad for you and it's bad for workers.” 

The sugar industry, however, rejects suggestions that it is causing the epidemic of CKD among workers at its mills and plantations.

“We are not responsible for it,” said Mario Amador, a spokesman for the sugarcane industry. “We’re working to find a solution.”

He also blames the workers themselves, saying they drink too much alcohol. “It’s part of our culture,” Amador said. “It’s part of the things we do in our country. Poor people do it a lot.” 

Amador also speculated that active volcanoes in the region could have contaminated the water supply. But he admits he does not know why so many have died from CKD.

No matter what the research finds, Central America is unlikely to curb its cane production anytime soon. The world market for sugar is strong, and the industry receives direct help from abroad. 

The International Finance Corp., the private-sector arm of the World Bank, has provided loans of more than $100 million to promote production and biofuel in Nicaragua in recent years. Though the loans went to two plantations whose workers have been heavily affected by kidney disease, they were approved without formal consideration of the disease because the IFC did not find a link between the cane fields and CKD, according to the Associated Press. 

After workers complained about the loans, the IFC helped to negotiate an $800,000 donation to sponsor the ongoing Boston University study, the Center for Public Integrity reported. The money was provided by Nicaragua Sugar Estates Limited, a major sugar producer in the west of the country, part of more than $4 million it has committed toward research and community development in recent years.

Waiting to die
But for many in Chichigalpa, the results of the research – whatever they may be – will come too late. 

Like most of the men in this community, Maximiliano Lopez, spent years in the fields cutting sugarcane. He began at 5 a.m., when the air was cool, and continued to work as the sun beat down, sometimes logging 14 hours a day. Then he was informed he had CKD.

Even after his diagnosis, which bans him from working in the fields or at the mill, the muscular 32-year-old said he used a friend’s identification to return to cutting cane. Nicaragua is the second-poorest country in the Western Hemisphere, he explained, and many workers continue to work the harvest after being diagnosed with kidney disease because it is the only work they can find. 

“A lot of people do it out of necessity,” Lopez said. “They have a big family and they're the head of the household, so even if they're sick, you have to find work to support your family.” 

But, as Lopez and other cane workers eventually discovered, short-term survival may mean leaving behind the families that they labored so mightily to support.

“I began working there to earn a living and instead I earned death,” he said. “I’m just waiting for the day to come.” 

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Reuters, file

Zhang Tingzhen (center) is given a doll to play with by his mother Wei Xiuying while sitting beside his father Zhang Guangde at a Shenzhen hospital in southern China Sept. 26.

HONG KONG - Apple's largest contract manufacturer has been pushing for a Chinese worker left brain-damaged in a factory accident to be removed from hospital in a case that throws a harsh new spotlight on labor rights in China.

Zhang Tingzhen, 26, an employee of Taiwan firm Foxconn, had nearly half his brain surgically removed after surviving an electric shock at a plant in southern China a year ago. He remains in hospital under close observation by doctors, unable to speak or walk properly.

However, Foxconn, which is paying Zhang's hospital bills, has been sending telephone text messages to his family since July, demanding they remove him from hospital and threatening to cut off funding for his treatment -- a move the firm says would be justified under Chinese labor law.

Foxconn confirmed it had sent the messages, saying that under Chinese law the worker must submit himself to a disability assessment, a process that in Zhang's case would require him to be discharged from the Shenzhen hospital and travel the 43 miles to Huizhou, where he was first hired by Foxconn.

Risk of brain hemorrhage
The firm said in response to emailed questions that it would be prepared to return Zhang to the Shenzhen hospital after the assessment, though his father said Zhang was unfit to travel and that doctors felt he remained at risk of a brain hemorrhage.

The case has raised fresh questions over the labor record of Foxconn, one of the biggest and most high-profile private employers in China, after a series of well-publicized suicides among its army of around a million workers and recent outbursts of labor unrest.

Report: Riots break out at Foxconn factory in China

It has angered labor activists who say Zhang's plight also highlights China's patchy and sometimes precarious welfare system for workers seriously injured in industrial accidents and point out that there are many workers worse off than Zhang.

"They kept sending me SMSs every day to get my son out of hospital and to appear before an injury assessment body or they will stop paying all expenses, including his medical fees and our living expenses," Zhang's father, Zhang Guangde, said.

"You cannot imagine the suffering they put me through, how I had to fight every inch of the way just to get money so we can take care of our son," he added, speaking at his son's bedside at the Number 2 People's Hospital in Shenzhen.

Zhang was repairing a spotlight on an external wall at a Foxconn factory in Shenzhen, bordering Hong Kong, when he received an electric shock and fell 12 feet to the ground. He has since undergone five operations, has lost his memory, is incontinent and requires careful, regular monitoring.

Worker at Apple-supplier Foxconn in China: 'We're humans, we're not machines'

Workers who are disabled in workplace accidents and covered by insurance are eligible for compensation payouts, once their disability is assessed and graded by a panel of medical experts. The assessment is done after medical treatment is finished.

Foxconn sent the text messages -- and according to Zhang's father at one point briefly halted payments to the family -- despite a provincial law stipulating that injured workers can remain in treatment for up to two years before they must be assessed for disability compensation.

The company, however, denied that it delayed or stopped payments, saying it paid them on time.

Zhang, whose case was alerted to Reuters by labor activists, has been in hospital since October 2011.

'At the mercy' of system
Doctors at the Number 2 People's Hospital declined to comment for this article, but Zhang's father, 50, said they had not indicated that he could be discharged and had said they needed to keep his son under observation after implanting a tube in his body to drain fluid from his brain cavity to his bladder.

"The doctor told me they needed to monitor his condition and that for such serious injuries, a person was allowed to be treated in hospital for up to two years. After that, assessors can order treatment to be prolonged," the father said.

Labor activists in China say Zhang is just one of many thousands of Chinese workers who are left permanently disabled or chronically ill by workplace accidents, at the mercy of a system that often requires them and their families to fight degrading battles for treatment funding and compensation.

'This American Life' retracts damning report on Apple manufacturer Foxconn

"China now has laws specifying the types of compensation that are due to workers. But in many serious industrial accidents, companies still put workers or their families through a lot of suffering just to get what is due to them," said Choi Suet-wah of the Chinese Working Women Network in Hong Kong.

"They are robbed of their dignity," said Choi, who has extensive experience working with migrant workers in China.

Zhang is actually one of the lucky ones, social workers say, pointing out that Foxconn has at least been paying his hospital bills and the living expenses of his family, which has moved to Shenzhen from central China to be with him.

Worker suicide at Chinese plant of Apple supplier, Foxconn

They estimate that at least four out of 10 Chinese workers are not covered by any kind of insurance and are left to fend for themselves when seriously injured in the workplace -- despite laws requiring all employers to insure their workers.

"This is just one of many, many industrial accidents in China. And you almost certainly never get what you are entitled to, especially in serious cases," Choi said.

Dad: Son calls me 'mother'
Foxconn says it is insured against workplace accidents, which means its insurer would meet the cost of a compensation payment once Zhang's disability is finally assessed.

But compensation in China can vary depending on the city in which a worker's disability is assessed, and this, according to Zhang's family, is why Foxconn wants him to travel to Huizhou and refuses to have him assessed in Shenzhen.

Labor activists say wages and compensation levels are all substantially lower in Huizhou than in Shenzhen, one of the most expensive cities in China.

When asked why Zhang could not be assessed in Shenzhen, Foxconn said the law required him to go to Huizhou because he had signed his employment contract there. It added that it was prepared to send him back to the hospital in Shenzhen if the assessors determined that he required more medical attention.

In hospital, Zhang walks unsteadily, holding on to the bed frames of other patients in his shared room and, with a smile, sits down next to his father whose face tightens with emotion.

"He calls me 'mother' and calls my wife 'father.’ He can only mimic words you ask him to say, it is meaningless," the elder Zhang said later, holding a jar containing large fragments of his son's cranium. Doctors replaced a portion of Zhang's skull with synthetic bone.

He said that despite Foxconn's funding -- a monthly allowance of 11,000 yuan ($1,800) plus treatment costs -- the family had racked up 200,000 yuan ($31,800) in debt to pay for medicines not provided by the hospital and other expenses.

Back home in central Henan province, the family was building a house for Zhang to live in after his impending marriage when he was injured.

"We were building a three-story house," the elder Zhang said. "The project has since been abandoned and all the building materials we bought have been washed away by rain. But these workers still have to be paid. My whole life is over."

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