The 20-page Dignitas infinita, or Infinite Dignity, published on Monday by the Vatican’s powerful department of doctrine, is the culmination of five years of work.

It was released as the Catholic Church is split over a range of social issues and covers the key themes of Francis’s 11-year papacy, from war to ecology and social justice.

While the document reaffirms the church’s long-held opposition to abortion and euthanasia, the Vatican has now also 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 people must not tinker with that plan or try to “make oneself God”.

It acknowledged the possibility of surgery to resolve “genital abnormalities” but stressed that “such a medical procedure would not constitute a sex change in the sense intended here”.

The declaration also said surrogate parenting violates the dignity of both the surrogate mother and the child and recalled that Francis in January called it “despicable” and urged a global ban.

The Vatican also reasserted its opposition to the criminalisation of homosexuality, which still exists in many countries, particularly in Africa.

“It should be denounced 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,” it said.

“We do not talk much about this violation of human rights, … and it is painful that some Catholics defend these unfair laws,” Victor Manuel Fernandez, head of the Dicastery of the Doctrine of the Faith, said at a news conference.

Document does not apply to ‘gender diverse people’

The pope 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 colonisation” of the West in the developing world, where development aid is sometimes conditioned on adopting Western ideas about gender and reproductive health.

Advocates for LGBTQ Catholics have criticised Monday’s document as outdated, harmful and contrary to the stated goal of recognising the “infinite dignity” of all of God’s children.

They also warned it could have real-world effects on trans people, fuelling 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, honoured and loved, it does not apply this principle to gender-diverse people,” Francis DeBernardo of New Ways Ministry, which advocates for LGBTQ Catholics, told The Associated Press news agency.

Transgender activists also 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 healthcare — 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,” Mara Klein, a nonbinary, transgender activist who has participated in Germany’s church reform project, told The Associated Press.

“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 noted.

“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.”

Monday’s declaration 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 young people — and in some cases adults.

In addition, bills to govern students’ pronouns, trans participation on sports teams and use of bathrooms at schools are also under consideration as well as how the issue should be handled in books and school curriculums.