The 23-page document — titled Dignitas infinita, or “infinite dignity” in Latin — amounted to a sweeping pronouncement on the human condition marking the 75th anniversary of the Universal Declaration of Human Rights issued by the United Nations. It warned of the ills of poverty, the plight of migrants and modern challenges to the concept of dignity, including cyberbullying.

But its briefer sections on gender theory and gender-affirming care were perhaps its most anticipated.

In recent months, Francis, in conjunction with Cardinal Victor Manuel Fernandez — his new right-hand man and a fellow Argentine who now heads the powerful Dicastery of the Doctrine of the Faith — has approved a series of more inclusive measures, including the blessings of couples in same sex unions with brief benedictions and the authorization of transgender people to be baptized and to serve as godparents. Last year, Francis also told a young transgender Italian that “the Lord loves us as we are.”

Those gestures and others have stoked a powerful conservative backlash, prompting criticism of Francis in often remarkably harsh terms and leading senior clerics in Africa, Eastern Europe and Asia in particular to reject Vatican guidance on blessings for same-sex couples despite caveats that they cannot share any similarity to the sacrament of marriage.

The document released Monday, approved by the pope on March 25, does not undo those measures or fundamentally change Francis’s more inclusive stance. It asserts, for instance, that the Catholic Church “wishes, first of all, to reaffirm that every person, regardless of sexual orientation, ought to be respected in his or her dignity and treated with consideration, while every sign of unjust discrimination is to be carefully avoided.”

But it does add context. It appeared to separate the need to provide outreach to transgender people from the act of obtaining gender-affirming surgery. It cites Francis as saying that “creation is prior to us and must be received as a gift. At the same time, we are called to protect our humanity, and this means, in the first place, accepting it and respecting it as it was created.”

The document concludes that this means “sex-change intervention … risks threatening” human dignity. The church, however, saw nothing wrong with “people born with genital abnormalities” seeking medical treatment.

The document takes aim at “gender theory,” or the notion that gender identities exist along a spectrum and can involve individual choice. In the past, Francis has sharply denounced the idea, even comparing it to nuclear weapons in 2015.

The Vatican document on Monday doubled down on that opposition, saying gender theory “intends to deny the greatest possible difference that exists between living beings: sexual difference.”

The document also exalts heterosexuality: “In the male-female couple, this difference achieves the most marvelous of reciprocities. It thus becomes the source of that miracle that never ceases to surprise us: the arrival of new human beings in the world.”

The Vatican further reiterated Francis’s opposition to surrogate pregnancies, contending the practice violates the dignity of women and turns a child into a “mere object.” The document warns against the increasing legalization of euthanasia and assisted suicide, arguing that “even in its sorrowful state, human life carries a dignity that must always be upheld, that can never be lost.” Echoing long-held church teaching, the document condemns abortion as a “deliberate and direct killing.”

Fernandez notes that the pope requested an earlier draft include a greater focus on the human dignity lost because of poverty, as well as sections on the dignity of migrants, violence against women and other themes. Noting a surge in global conflict, the Vatican repeated Francis’s belief that a third world war is already being fought “piecemeal.” The Vatican additionally appeared to slam wealthy countries for tougher policies against migrants. “No one will ever openly deny that they are human beings; yet in practice, by our decisions and the way we treat them, we can show that we consider them less worthy, less important, less human.”

Its sharpest focus was on a subject Francis has frequently railed against: poverty. World leaders have heralded numbers that have shown reductions in global poverty, but the Vatican argued that this does not take into account rising inequality and the hoarding of wealth by the few. The document found the Vatican under Francis once again calling out consumer culture and corporations — described as the “empire of money” — that downsize employees in a quest for higher profits.

“The claim that the modern world has reduced poverty is made by measuring poverty with criteria from the past that do not correspond to present-day realities,” the document stated. “As a result, poverty can take a variety of forms, such as an obsession with reducing labor costs with no concern for its grave consequences.”