Working with phone call audio?

Is it possible (and if not, why isn't it possible) for developers to access live phone call audio through an app? I know of a few apps that allow users to equalize sound from music/media apps, but none that can manipulate phone call audio. Is this just a security feature to prevent malicious developers from recording calls?
The AVSpeechSynthesizer API allows you to insert speech into an outgoing call:

https://developer.apple.com/documentation/avfoundation/avspeechsynthesizer/3132070-mixtotelephonyuplink

However this is the only functionality that we have (as far as I know) regarding modifying the call audio. I also don't know of a way to "read" the audio from the call, I am pretty sure that's not possible.
Working with phone call audio?
 
 
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