The Vatican declared Monday that transgender surgeries, surrogacy, and gender theory are threats to human dignity, breaking with the progressive approach to social issues that Pope Francis has adopted in recent years.

In a 20-page document titled “Infinite Dignity,” the Vatican argues these practices are comparable to euthanasia or abortion as violations of God’s plan for human life. The declaration, five years in the making, was signed and approved by Pope Francis, who ordered it to be written and published.

In the document, the Vatican doctrine office formally rejects gender theory and any attempt to change one’s gender, for the most part, while upholding the fact that men and women are biologically different.

“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 reads.

While transgender procedures are a grave threat, it says medical intervention is allowed for those with “gender abnormalities” present at birth or that develop later in life. Doctors can “resolve” those abnormalities, the declaration notes.

The Vatican also addresses surrogacy, saying it violates both the dignity of the surrogate mother and the 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 states. “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.”

This statement is in line with Pope Francis recently calling for a global ban on surrogacy.

The pope has taken increasingly progressive positions on homosexuality and the wider LGTBQ+ movement by allowing priests to bestow blessings on same-sex couples and extending baptismal privileges to transgender Catholics.

However, he has also called gender theory an “ugly ideology” for erasing the distinctions between men and women. The new Vatican document quotes him as likening it to “ideological colonization,” which he says is holding the Western world for ransom.

“It needs to be emphasized that biological sex and the sociocultural role of sex (gender) can be distinguished but not separated,’” the text reads.

In response to the publication of “Infinite Dignity,” transgender activists called the document “hurtful” for leaving out the voices and experiences of trans 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 worked to push the Catholic Church in Germany to adopting the views of the LGBT political movement.

“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,” she added.