VATICAN CITY >> The Vatican today declared gender-affirming surgery and surrogacy as grave violations of human dignity, putting them on par with abortion and euthanasia as practices that it said reject God’s plan for human life.

The Vatican’s 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.

From a pope who has made outreach to the LGBTQ+ community a hallmark of his papacy, the document was received as a setback, albeit predictable, by trans Catholics. But its message was also consistent with the Argentine Jesuit’s long-standing belief that while trans people should be welcomed in the church, so-called “gender ideologies” should not.

In its most eagerly anticipated section, the Vatican repeated its rejection of “gender theory,” or the idea that one’s biological sex can change. It said God created man and woman as biologically different, separate beings, and said people must not tinker with that 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.

Advocates for LGBTQ+ Catholics immediately criticized the document as outdated, harmful and contrary to the stated goal of recognizing the “infinite dignity” of all of God’s children. They warned it could have real-world effects on trans people, fueling anti-trans violence and discrimination.

“While it lays out a wonderful rationale for why each human being, regardless of condition in life, must be respected, honored, and loved, it does not apply this principle to gender-diverse people,” said Francis DeBernardo of New Ways Ministry, which advocates for LGBTQ+ Catholics.

Nicolete Burbach, lead expert in social and environmental justice at the London Jesuit Centre, said the document showed the Vatican continues to fail to engage with queer and feminist approaches to the body “which it simply dismisses as supposedly subjecting both the body and human dignity itself to human whims.”

“I think the main difficulty faced by the document is that it attempts to affirm the church’s authentic commitment to human dignity in the face of a troubling history on the part of the church itself around attacks on that dignity,” said Burbach, a trans Catholic theologian who researches transness and the Catholic Church.

The document’s existence, rumored since 2019, was confirmed in recent weeks by the new prefect of the Dicastery for the Doctrine of the Faith, Argentine Cardinal Víctor Manuel Fernández, a close Francis confidant.

Fernández had cast the document 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, in an apparent attempt at balance, 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.”

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 White House said President Joe Biden, a devout Catholic, was “pleased” to see that the declaration “furthers the Vatican’s call to ensure that LGBTQ+ (individuals) are protected from violence and imprisonment around the world,” press secretary Karine Jean-Pierre said.

On the specifics involving gender theory, Jean-Pierre stressed that it was not Biden’s role to “litigate internal church policy.”

Asked how its negative take on trans people squared with Francis’ message of welcome, Fernández said the welcome remained but that the pope fervently believed that the idea that gender was fluid “rather than helping to recognize dignity, impoverishes the vision” of a man and woman coming together to create new life.

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, the death penalty 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 asserts that 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.”

“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,” it said.

The Vatican had previously 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.

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 doesn’t repeat Vatican doctrine that homosexual people deserve to be treated with dignity and respect but that homosexual actions are “intrinsically disordered.”

In a news conference to introduce the document, Fernández acknowledged that the “intrinsically disordered” language was very strong. He suggested there might be a better way, “with other words,” to express the church’s vision of sex between husband and wife to create new life.

Francis has ministered to trans Catholics, including trans sex workers, and insisted 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.

Transgender activists immediately called the document “hurtful” and devoid of the voices and experiences of real trans people, especially in the distinction it makes between gender-affirming surgeries and surgeries on 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 people’s dignity is not only hurtful but dangerously ignorant,” said Mara Klein, a nonbinary, transgender activist who has participated in Germany’s church reform project.

Klein said the Vatican “hypocrisy” was furthered by the document’s approval of surgery on intersex people, “which if performed without consent especially on minors often cause immense physical and psychological harm.”

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.

“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.

AP writer Darlene Superville contributed from Air Force One.