VATICAN CITY (AP) The Vatican on Monday declared gender-affirming surgery and surrogacy as grave violations of human dignity , putting them on par with abortion and euthanasia as practices that reject Gods plan for human life.

The Vaticans doctrine office issued Infinite Dignity, a 20-page declaration that has been in the works for five years. After substantial revision in recent months, it was approved March 25 by Pope Francis, who ordered its publication.

In its most eagerly anticipated section, the Vatican repeated its rejection of gender theory, or the idea that ones gender can be changed. It said God created man and woman as biologically different, separate beings, and said people must not tinker with that plan or try to make oneself God.

It follows that any sex-change intervention, as a rule, risks threatening the unique dignity the person has received from the moment of conception, the document said.

It distinguished between gender-affirming surgeries, which it rejected, and genital abnormalities that are present at birth or that develop later. Those abnormalities can be resolved with the help of health care professionals, it said.

The documents existence, rumored since 2019, was confirmed in recent weeks by the new prefect of the Dicastery for the Doctrine of the Faith, Argentine Cardinal Vctor Manuel Fernndez, a close Francis confidant.

He had cast it as something of a nod to conservatives after he authored a more explosive document approving blessings for same-sex couples that sparked criticism from conservative bishops around the world, especially in Africa.

And yet, the document takes pointed aim at countries including many in Africa that criminalize homosexuality. It echoed Francis assertion in a 2023 interview with The Associated Press that being homosexual is not a crime, making the assertion now part of the Vaticans doctrinal teaching.

The new document denounces as contrary to human dignity the fact that, in some places, not a few people are imprisoned, tortured, and even deprived of the good of life solely because of their sexual orientation.

The document is something of a repackaging of previously articulated Vatican positions, read now through the prism of human dignity. It restates well-known Catholic doctrine opposing abortion and euthanasia, and adds to the list some of Francis main concerns as pope: the threats to human dignity posed by poverty, war, human trafficking and forced migration.

In a newly articulated position, it says surrogacy violates both the dignity of the surrogate mother and the child . While much attention about surrogacy has focused on possible exploitation of poor women as surrogates, the Vatican document focuses almost more on the resulting child.

The child has the right to have a fully human (and not artificially induced) origin and to receive the gift of a life that manifests both the dignity of the giver and that of the receiver, the document said. Considering this, the legitimate desire to have a child cannot be transformed into a right to a child that fails to respect the dignity of that child as the recipient of the gift of life.

The Vatican published its most articulated position on gender in 2019, when the Congregation for Catholic Education rejected the idea that people can choose or change their genders and insisted on the complementarity of biologically male and female sex organs to create new life.

It called gender fluidity a symptom of the confused concept of freedom and momentary desires that characterize post-modern culture.

The new document from the more authoritative Dicastery for the Doctrine of the Faith quotes from that 2019 education document, but tempers the tone. Significantly, it doesnt repeat the 1986 language of a previous doctrinal document that said homosexual people deserve to be treated with dignity and respect but that homosexual actions are intrinsically disordered.

The Rev. James Martin, who has called for the Catholic Church to extend greater outreach to LGBTQ+ Catholics, said the gender terminology was similar to past declarations. But he welcomed the condemnation of legislation and violence against LGBTQ+ people.

That cannot be repeated too often as an offense against human dignity. The LGBTQ person, like everyone else, has infinite dignity, he said in an email.

Francis has made reaching out to LGBTQ+ people a hallmark of his papacy, ministering to trans Catholics and insisting that the Catholic Church must welcome all children of God.

But he has also denounced gender theory as the worst danger facing humanity today, an ugly ideology that threatens to cancel out God-given differences between man and woman. He has blasted in particular what he calls the ideological colonization of the West in the developing world, where development aid is sometimes conditioned on adopting Western ideas about gender and reproductive health.

It needs to be emphasized that biological sex and the sociocultural role of sex (gender) can be distinguished but not separated, the new document said.

Transgender activists immediately called the document hurtful and devoid of the voices and experiences of real trans people, especially in its distinction between transgender people and intersex people.

The suggestion that gender-affirming health care which has saved the lives of so many wonderful trans people and enabled them to live in harmony with their bodies, their communities and (God) might risk or diminish trans peoples dignity is not only hurtful but dangerously ignorant, said Mara Klein, a nonbinary, transgender activist who has participated in Germanys church reform project.

Seeing that, in contrast, surgical interventions on intersex people which if performed without consent especially on minors often cause immense physical and psychological harm for many intersex people to date are assessed positively just seems to expose the underlying hypocrisy further, Klein said.

The document comes at a time of some backlash against transgender people, including in the United States where Republican-led state legislatures are considering a new round of bills restricting medical care for transgender youths and in some cases, adults. In addition, bills to govern youths pronouns, sports teams and bathrooms at school are also under consideration, as well as some books and school curriculums.

On top of the rising hostility towards our communities, we are faced with a church that does not listen and refuses to see the beauty of creation that can be found in our biographies, Klein said in an email.