Vatican City | The Vatican on Monday declared sex change operations and surrogacy as grave threats to human dignity, putting them on par with abortion and euthanasia as practices that violate 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.

In its most eagerly anticipated section, the Vatican repeated its rejection of “gender theory” or the idea that one's gender can be changed. It said God created man and woman as biologically different, separate beings, and said they 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 transitioning 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 document's existence, rumoured 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 Pope Francis confidante.

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 while rejecting gender theory, the document takes pointed aim at countries — including many in Africa — that criminalise 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 Vatican's 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. 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 characterise 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 doesn't repurpose the 1986 language of a previous doctrinal document saying that homosexual people deserve to be treated with dignity and respect but that homosexual actions are “intrinsically disordered.” 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.

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.